Background/Objectives:Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the staging and treatment of testicular cancer and is often mandatory. RPLND is associated with a high risk of morbidity. The use of minimally invasive techniques has significantly increased the number of robotic procedures performed over the last few years. This study aimed to analyze the perioperative and postoperative outcomes and trends of an increasing number of surgeries performed.Materials and Methods:We retrospectively analyzed 30 robotic RPLNDs (R-RPLNDs) performed at our testicular cancer center between 2020 and 2024. Logistic regression analyses were used to analyze the independent variables of operative time (OT), hospital stay (HS), estimated blood loss, lymph node yield, and complications according to the Clavien–Dindo classification system. The independent predictors included case number, clinical stage, post-chemotherapy status, preoperative retroperitoneal tumor mass, and body mass index. Furthermore, the patients were categorized into three groups: group A (cases 1–10), group B (cases 11–20), and group C (cases 21–30). A Kruskal–Wallis test was performed to assess differences among the groups concerning OT, HS, and lymph node yield.Results:OT significantly decreased with an increasing number of cases (p< 0.001), and HS was significantly affected by overall complications (p= 0.0006). There were two major perioperative complications (6.6%). No factors predicted overall complications or Clavien–Dindo grades I-II or III–V. The Kruskal–Wallis test showed a significant difference (p< 0.05) in OT and HS for group C.Conclusions:R-RPLND for GCTs demonstrates a clear learning curve, with significant improvements in OT, HS, and complication rates as surgeons gain experience. Overall, the low complication rates for R-RPLND did not indicate predictive factors for perioperative or postoperative complications. RPLND presents promising potential as a safe and effective treatment for GCTs, especially when performed by experienced surgeons in specialized centers.
背景/目的：腹膜后淋巴结清扫术（RPLND）在睾丸癌的分期和治疗中起着关键作用，且通常为必要手段。该手术伴随较高的并发症风险。近年来，微创技术的应用显著增加了机器人手术的实施数量。本研究旨在分析手术数量增长背景下的围手术期及术后结果与趋势。 材料与方法：我们回顾性分析了2020年至2024年间在本中心睾丸癌诊疗中心实施的30例机器人辅助腹膜后淋巴结清扫术（R-RPLND）。采用逻辑回归分析手术时间、住院天数、预估失血量、淋巴结检出数量及根据Clavien-Dindo分级系统评估的并发症等自变量。独立预测因素包括手术序号、临床分期、化疗后状态、术前腹膜后肿瘤负荷及体重指数。此外，将患者分为三组：A组（第1-10例）、B组（第11-20例）和C组（第21-30例）。采用Kruskal-Wallis检验评估各组间手术时间、住院天数和淋巴结检出数量的差异。 结果：随着手术例数增加，手术时间显著缩短（p<0.001），住院天数受总体并发症显著影响（p=0.0006）。发生两例重大围手术期并发症（6.6%）。未发现预测总体并发症或Clavien-Dindo I-II级与III-V级并发症的影响因素。Kruskal-Wallis检验显示C组在手术时间和住院天数方面存在显著差异（p<0.05）。 结论：R-RPLND治疗生殖细胞肿瘤存在明确的学习曲线，随着术者经验积累，手术时间、住院天数和并发症发生率均显著改善。总体而言，R-RPLND的低并发症率未显示围手术期或术后并发症的预测因素。该术式作为生殖细胞肿瘤的安全有效治疗方法展现出良好前景，尤其在专科中心由经验丰富的外科医师实施时更为显著。
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