title: A novel "intuitive" surgical technique for right robot-assisted retroperitoneal lymph node dissection for stage I testicular NSGCT.
abstract: OBJECTIVE
  To describe a new technique for the right template RPLND able to offer a optimal exposure of surgical field, minimal bowel mobilization, and enabling a more "openlike dissection" technique.
  
  
  METHODS
  We used a variant of the aortic lymphadenectomy previously described by Magrina et al. for gynecologic malignancies. The patient is placed in a steep Trendelenburg, supine position and the robot column, at the patient's head. The trocar position is specular to that used for RALP and known for generating no collision between the robotic arms. The node dissection of the right template, including laterocaval and interaortocaval nodes, is carried out like in the "open" split-and-roll technique.
  
  
  RESULTS
  The docking time was 15', the console time was 192', the blood loss was irrelevant (50 mL), and the number of retrieved nodes was 19. The exposure of the infrarenal vein region of the operatory field resulted optimal without extensive bowel mobilization. The dissection perfectly mimicked the open procedure.
  
  
  CONCLUSIONS
  As the left RPLND template includes only para-aortic lymph nodes, the left full flank position seems adequate. On the contrary, it enables a less good exposure of the more extensive right RPLND template, requiring excellent robotic surgical skills to overpass related deadlocks. On the contrary, our technique allows adequate and safe performance of the robotic. It enables a good view of the retroperitoneal space reducing the need of bowel mobilization to obtain a good exposure of the operatory field. Moreover, the patient's supine position makes the procedure more similar to the open technique.
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: de Cobelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
authors.forename: Federica
authors.initials: F
authors.lastname: Mazzoleni
authors.forename: Gennaro
authors.initials: G
authors.lastname: Musi
authors.forename: Deliu Victor
authors.initials: DV
authors.lastname: Matei
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D012187:Retroperitoneal Space; D012371:Robotics / Q000379:methods*; D016683:Supine Position; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome