V1034 MIDLINE EXTRAPERITONEAL APPROACH FOR RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR GERM CELL TUMOR

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THE JOURNAL OF UROLOGY姞

nonseminomatous germ cell tumors. The relatively short learning curve of robotic surgery is providing a comparative advantage over laparoscopic techniques. We report our technique for robot-assisted RPLND in a patient with clinical stage I non-seminomatous testicular cancer. To our knowledge this is the first video description of a left-sided template. METHODS: Our patient was a 25-year-old man who underwent a left orchiectomy for a mixed non-seminatous germ cell tumor (90% embryonal) with lymphovascular invasion (Stage 1B). Tumour markers were slightly elevated on admission. Staging CT scans were negative for nodal metastatic disease. The patient underwent a left-sided modified nervesparing template RPLND. The technique demonstrated is a transperitoneal 5-port approach with dissection contained to the left ureter laterally, great vessels medially, renal vein superiorly and bifurcation of common iliacs inferiorly. Hem-O-lok clips (Weck, Teleflex Medical, NC, USA) and robotic Harmonic™ device (Ethicon Endosurgery, OH, USA) were used for ligation of lymphatic channels. All lymphatic tissue was placed in an endoscopic bag and extracted via the periumbilical camera port. RESULTS: Operative time was 205 minutes. Estimated operative blood loss was 110mL and the patient’s post-operative hemoglobin dropped by 0.5 g/dL. The patient was discharged from the hospital postoperative day 1. The final specimen demonstrated pre-aortic, paraaortic and inter-aortocaval nodes with metastatic embryonal carcinoma in 6 of 28 lymph nodes and no evidence of extranodal extension. The patient thereafter underwent 3 cycles of Bleomycin, Etoposide and Cisplatin chemotherapy. Follow-up surveillance scans to date (12 months) do not demonstrate evidence of disease recurrence. CONCLUSIONS: Robot-assisted repair of RPLND results in good lymph node yield, short hospital stay and low morbidity. New instrumentation such as the robotic Harmonic™ device is especially useful in this procedure for ligation of lymphatic channels. Analysis of larger case series is required before this technique can be compared to open RPLND. Source of Funding: None

V1034 MIDLINE EXTRAPERITONEAL APPROACH FOR RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR GERM CELL TUMOR Kenneth Faber*, Sumeet Syan, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Retroperitoneal lymph node dissection (RPLND) for treatment of germ cell testicular tumor (GCT) can be technically difficult and associated with significant morbidity. We present a video describing a midline extraperitoneal (EP) approach that may decrease perioperative complications, particularly gastrointestinal morbidity. METHODS: This video illustrates an 8-step approach for a midline extraperitoneal retroperitoneal lymph node dissection. The representative example utilizes an extended left-sided template including dissection of the inter-aortocaval nodes, with a second example of a completed extended right-sided template including the inter-aortocaval and para-arotic nodes. RESULTS: Between April 2010 and October 2011, we performed 16 extraperitoneal RPLNDs, 8 were primary procedures, and 8 were post-chemotherapy. The steps outlined in the video include: 1) Midline incision from xiphoid to pubis, including incision through anterior and posterior rectus fascia; 2) Development of space between transversalis fascia and peritoneum; 3) Medial sweep of peritoneal contents off the lateral abdominal wall and posterior rectus sheath; 4) Development of plane between Gerota’s fascia and the peritoneum; 5) Placement of table-fixed retractor to retract peritoneal sac and abdominal wall; 6) RPLND performed in standard fashion; 7) Application of tissue sealant; and 8) Closure. CONCLUSIONS: An extraperitoneal approach to retroperitoneal lymph node dissections can be performed safely without prolonged operative times or compromised lymph node retrieval even in the post-chemotherapy setting. Source of Funding: None

Vol. 187, No. 4S, Supplement, Monday, May 21, 2012

V1035 MEDIAL PYELOLYMPHATIC DISCONNECTION: A NEW CONCEPT IN THE SURGICAL MANAGEMENT OF RECURRENT CHYLURIA. Saurabh Chipde*, Anil Mandhani, Lucknow, India

WITHDRAWN

History Forum Monday, May 21, 2012

1:00 PM-5:30 PM

1036 THE LIFE AND UROLOGIC CONTRIBUTIONS OF ABRAHAM COLLES (1773-1843) Zachary Klaassen*, Augusta, GA; Brian J. Shayota, Kim Oelhafen, St. George’s, Grenada; Mohammadali M. Shoja, R. Shane Tubbs, Birmingham, AL; Marios Loukas, St. George’s, Grenada; Martha K. Terris, Augusta, GA INTRODUCTION AND OBJECTIVES: Named after his maternal grandfather, Abraham Colles was born in a town just south of Dublin, known as Milmount, Ireland on July 23, 1773. As a child, Colles went to school in Kilkenny before making his way to the University of Dublin and eventually receiving his diploma from the Royal College of Surgeons in Dublin in 1795. Colles would go on to make significant contributions in the fields of microbiology, orthopedic surgery, anatomy and urology. METHODS: Sources from medical journals, the history of medicine and the field of urology were analyzed regarding the life and contributions of Abraham Colles. RESULTS: Colles advanced his expertise by traveling to Edinburgh to earn an MD in 1797 after defending his doctoral thesis titled “De venesectione.” Most importantly to the field of urology, Colles described the fascia that is continuous with the dartos layer of the scrotum and membranous layer of the superficial fascia of the anterior abdominal wall (Scarpa’s fascia). Clinically, extravasation of blood through the deep penile fascia (Buck’s fascia), but confined by Colles’ fascia, results in a “butterfly” perineal and scrotal hematoma that may extend up to the anterior abdominal wall. Colles also described the small triangular fascia that runs from the pubic crest to the iliopectineal line and extends upwards and inwards toward the linea alba. Colles extended his interest into the realm of microbiology and genitourinary medicine while studying venereal disease (specifically syphilis) from which Colles’ Law was derived: A child born to a mother who has no signs of venereal symptoms, and presents with this disease at the age of a few weeks, will infect the healthiest nursemaid, but not its mother. In the same book (Practical Observations on the Venereal Disease, and on the use of Mercury), Colles also advocated the use of mercury in the treatment of syphilis, which Colles believed to be his most important discovery. While time would prove this discovery to be false, Colles’ intentions were genuine as syphilis was highly stigmatized at the time. CONCLUSIONS: There is no doubt that Abraham Colles made a substantial contribution to our current knowledge of anatomy and urology. Thus, while Colles may not have been a surgical giant, his integrity and commitment to medicine, anatomy and urology has transcended time and deserves recognition. Following his death secondary to complications of gout on November 16, 1843, all medical schools in the Irish metropolis suspended their proceedings and a tribute was paid to Colles by the College of Surgeons and the College of Physicians. Today, Colles’ remains lie in the cemetery of Mount Jerome. Source of Funding: None