Vascular challenges in robotic-assisted retroperitoneal lymph node dissection (RA-RPLND)

To depict approaches on how to handle challenging robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) cases. Case 1: 39-year-old male patient with a right testicular mass. The right orchiectomy showed pT2 nonseminomatous germ cell tumors (NSGCTs). Complete staging showed stage IIIC with a retroperitoneal mass, measuring 16×11.4 cm. He completed four cycles of bleomycin (Bleomycin), etoposide (Etoposide), and cisplatin (BEP). On follow-up, tumor markers were normalized, and a CT scan showed an interval decrease in the size of the right retroperitoneal mass measuring 4.0 × 3.2 cm. The patient elected to proceed with RA-RPLND. Case 2: 28-year-old male patient with a history of right testicular mass and incidental Urachal mass. The right orchiectomy showed pT1 NSGCTs. Complete staging showed stage IIB with a retroperitoneal mass measuring 3 × 2 cm. He completed four cycles of BEP. On follow-up, tumor markers were normalized, and a CT scan showed persistent para-aortic mass measuring 3 × 2 cm. The patient was elected to proceed with RA-RPLND and a partial cystectomy. Note: A short clip of an aortic injury showing the layers and concern for proximity to the aorta during RA-RPLND and bleeding control was added at the end of the video. The average console time was 135 min, with an average estimated blood loss of 100 mL. There were no intraoperative and postoperative complications, and the patients were discharged on postoperative day 1. RA-RPLND is a safe and effective treatment for testicular cancer patients in experienced centers.