Retroperitoneal Lymphadenectomy for Clinical Stage I Nonseminomatous Testicular Tumor: Laparoscopy Versus Open Surgery and Impact of Learning Curve

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Abstract
Laparoscopic retroperitoneal lymphadenectomy for clinical stage I nonseminomatous testicular tumors was compared to open surgery, taking into account the impact of the learning curve. Between August 1992 and September 1995, 29 consecutive patients underwent laparoscopic retroperitoneal lymphadenectomy. Open surgical retroperitoneal lymphadenectomy was performed on 30 patients between January 1988 and July 1992. A comparison of the 14 initial and 15 subsequent laparoscopies showed a steep learning curve (operative time shorter by 36%, blood loss decreased by 50% and postoperative hospital stay shorter by 27%). When comparing the last 15 laparoscopic procedures to the open operations, the latter were superior only in terms of operative time (shorter by 18%). With regard to all other parameters open surgery was inferior (increased blood loss by 38%, longer postoperative hospital stay by 166%, more serious complications and a greater complication rate). Antegrade ejaculation was preserved after all laparoscopic and after 28 of the 30 open operations. There were no retroperitoneal recurrences in either group (mean followup 16 months after laparoscopy and 54 months after open surgery). Laparoscopic retroperitoneal lymphadenectomy is a demanding operation that is superior to open surgery once the learning curve has been overcome. However, this is possible only if laparoscopic retroperitoneal lymphadenectomy is performed on a regular basis.