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Retroperitoneal lymphadenectomy
Testicular cancer appears in young age. It is of different types due to the difference in the cells of origin. The testis, like any other organ in our  body, drains its major metabolites through the lymph vessels to certain well defined lymph station (lymph nodes).

The lymph nodes draining the testis are presend in the retro peritoneal space. This is the space behind our intestine. It includes the major vessels of the body like namely the aorta and vena cava as well as some nerves including the sympathetic and parasympathetic nerve fibres.

The removal of the lymph nodes draining the testis in theis space is called retroperitoneal lymphadenectomy. It is important to spare the nerves of the area in particular the sympathetic nerves to avoid that the patient may ejaculate inside the bladder after the sexual act (retrograde ejaculation). Sparing these important nerves as a part of the operation is called nerve sparing retroperitoneal lymohadenectomy.




The sympathetic nerve chain runs around the aorta
walled and the lymph nodes.
LN = lymph node
N = nerve and sympathetic nerve chain



Who qualifies for the operation?

Patients who have a histological evidence of testicular cancer and who may have evidence of restricted metastasis in their lymph nodes or those who do not have any evidence of metastasis and undergo the operation as a prophylactic measure when wait and see strategy is not recommended.

How does the operation works?

The patient lyes on his back. The incision is done from underneath the thorax to the end of the lower abdomen. The peritonium is opened at the front of the abdomen. the intestines are wraped inside wet warm towels and are carefuly kept to the outside of the abdomen. The liver is protected under a warm wet towel und a broad smooth retractor. The retroperitoneal raum is reached through an incision of the hind flap of the peritonium. The vessels, nerves and lymph nodes are inspeceted. The nodes of the sympathetic nerve chain and the pelvis nerves are located and maped. The area where the lymph nodes are to be removed is maped dependant on the diseased side of the testis. The lymph nodes are selecte and removed with special care to the nerves and vessels of the area.

Care is taken for bleeding and lymph vessels. The peritonium of the back of the abdomen is closed  The intestine is returned to its place. The peritonium of the front of the abdomen is closed. The wound is closed and dressed.





Incision



Frequently asked questions (FAQ):
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  1. Is it mandatory to remove the lymphnodes of the retroperitomium for every case of testicular cancer?
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    No, This is done when they are minimally involved or when a prophylactic step is needed to avoid there indulgement in the disease later on. There is a policy called wait and see which is sasiticaly and scientificaly nearly similar to the removal of the lymph nodes and it avoids the risk of the operation too. The selection of the treatment meathod is dependant on the individual case.
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  2. What is retrograde ejaculatin?
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    Normal ejaculation is antigrade. This means the semen passes the urethra to the outside. This happens because the bladder neck becomes closed during ejaculation. This functin is regulated by the sympathetic nerve system in particular the fibres present in the retroperitonium. If these fibres are injured, it happens that the bladder neck becomes opened during ejaculation. The semen flows then inside the baldder and will be voided with urine thereafter.
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  3. What are the compolication s of the operation?
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    The most important is retrograde ejaculation. The second is injury to the aorta or vena cava. These two complications are rae but they should be immediately corrected by the modern methods of vascular closure. Injury to the intestin, liver and nervs are less likely to happen. Infection and disturbance of wound healing are also rare expectations.
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  4. What is lymph collection?
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    It sometimes happen that one or more of the minute lymph vessels may start leakage. The fluid coming out is lymph. It collects in some place resulting in a collection called lymphocele. This is treated through wait and see and compression. It is rare to necessitates its aspiration under ultrasonic control.
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  5. Does the removal of lymph nodes guarantee that I will not suffer from metastasis of testicular cancer any more?
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    No, but it is a very good methode for much reducing the risk. In most cases the operation is a step towards complete healing.
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  6. What is the healing chance of testicular cancer?
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    The healing rate is 98% in particular after the high development of the combined chemotherapy.
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  7. When can I return to my activity after the operation?
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    You need two weeks of rest for the healing of the wound and stabilisation of your vital processes. You can return to slight work within 6-8 weeks after the operation.