Tips and Tricks for Robotic Retroperitoneal Lymph Node Dissection in Testicular Cancer

Introduction: Retroperitoneal lymph node dissection (RPLND) is a mainstay of surgical management for advanced testicular cancer, both in the first line and postchemotherapy settings. Robotic RPLND has been increasingly utilized in recent years as an alternative to the open approach. The aim of this video is to demonstrate some of the tips and tricks for an effective robotic RPLND. Materials and Methods: Two patients are illustrated in this video. The first patient is a 24-year-old man with a history of right testicular mixed germ cell tumor (99% seminoma, 1% embryonal carcinoma), who underwent primary robotic bilateral nerve-sparing RPLND for a 1.8 cm lesion in the retroperitoneum (IIA) with mildly elevated beta human chorionic gonadotropin of 4.4 mIU/mL. The second patient is a 37-year-old man with a history of left testicular cancer 15 years prior (unknown pathology) who previously received 3 cycles of bleomycin, etoposide, and cisplatin postorchiectomy for the advanced stage. He underwent robotic postchemotherapy RPLND because of a 9.6 cm retroperitoneal mass with negative tumor markers. Results: We first outline the appropriate patient positioning, port placement, and pneumoperitoneum. Next, we demonstrate how to secure the posterior peritoneum to the anterior abdominal wall. We then describe how to perform nerve sparing of the postganglionic sympathetic nerves. After this, we present the minimal tumor touch as well as the robotic split and roll techniques for thorough lymph node dissection. Finally, we include maneuvers that aid in dissection around the great vessels and the cisterna chyli in both primary and postchemotherapy settings. In both the aforementioned cases, no intra/perioperative complications were reported. Both patients were discharged on postoperative day 1. Conclusions: In this video, we present some of the tips and tricks for facilitating robotic RPLND, which can assist in obtaining optimal oncologic and functional outcomes while minimizing perioperative complications. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The authors declare that there is no conflict of interest in connection with this video. Runtime of video: 7 mins 58 secs