Clinical stage IIC testicular seminoma is treated with induction chemotherapy, post-chemotherapy masses are managed based on their size; if the mass is larger than 3 cm, an FDG PET scan is performed to assess the likelihood of viable tumor in the residual retroperitoneal mass. Post-chemotherapy retroperitoneal lymph node dissection (RPLND) poses significant challenges due to desmoplastic reactions and substantial perioperative morbidity. Despite these challenges, RPLND is crucial if the FDG-PET scan indicates activity in the post-chemotherapy mass. Here, we present a case of robot-assisted total retroperitoneoscopic left-sided modified lymph node dissection for clinical stage IIC post-chemotherapy left testicular seminoma, to explore the feasibility of this approach in such cases.

Following general anaesthesia, the patient was positioned in the right lateral decubitus position. Retroperitoneal access was achieved, and space was created using a two-glove finger balloon dissection technique. A 12mm working port was placed, and all three robotic ports (8mm) were inserted under direct vision in a linear arrangement. The surgical procedure was carried out as demonstrated in the accompanying video.

Although orientation took some time—primarily because we aimed to lift the peritoneum from the anterior part of the aorta to dissect up to the inter-aortocaval area—we successfully reoriented and performed the modified RPLND along with the removal of the full-length cord structure.

This robotic retroperitoneoscopic approach for RPLND is feasible, offering quick recovery and the inherent advantages of the retroperitoneoscopic method over the transperitoneal approach