Objectives: We highlight the technical aspects of robotically assisted right modified template retroperitoneal lymphadenectomy in a gentleman with mixed germ cell testicular cancer.
Methods and Procedures: The patient is a 20-year-old male with stage 1A mixed germ cell cancer of the right testicle. He was secured to the table in a right modified flank position. Once all ports had been inserted and the robot docked, the operation commenced with medial reflection of the ascending colon to expose the retroperitoneum. The vena cava was identified and exposed using sharp dissection to Kocherize the duodenum. The extent of our dissection was the right ureter laterally, the right renal artery superiorly, the anterior aorta medially, and the right common iliac artery inferiorly.
Results: The procedure time was 180 minutes. Blood loss was 150mL. Thirteen lymph nodes were obtained and were negative for cancer. The patient was discharged home on postoperative day 2 and recovered well with normal ejaculatory function.
Conclusion: Robotic-assisted retroperitoneal lymphadenectomy can be safely performed with reasonable operative time in appropriately selected patients. The improved visibility and dexterity offered by the robot allows for accurate dissection and prompt placement of hemostatic sutures during the procedure.
