Open retroperitoneal lymph node dissection (ORPLND) has long been the standard surgical approach for retroperitoneal metastases in testicular cancer. However, it is associated with significant morbidity, including prolonged hospital stays, postoperative ileus, and substantial postoperative pain. To mitigate these complications, Robotic-assisted RPLND is a significantly advanced minimally invasive surgery. We demonstrate that Robot assisted RPLND is feasible even in challenging cases with decreased morbidity.

23Yr old male presented with complaints of upper abdominal pain for past 1 year. On examination, had ill defined central abdominal mass, with left testicular mass. On evaluation with CECT found multiple retroperitoneal lymph nodes (largest in left paraaortic region 4x10cm ) with mediastinal LN, with Raised tumor markers ( AFP-44283 ng/ml HCG-492 mIU/mL, LDH 273 U/L). Patient underwent left HIO – HPE: Mixed GCT (95% teratoma , 5% seminoma). Post orchidectomy AFP-5070 ng/ml HCG-527 mlU/mL, LDH 255 U/L (S2). Patient received 4 cycles of BEP chemotherapy. Post Chemo- tumor markers normalized, but CT showed residual left paraaortic LN ((2.5 x 7.3cm), with resolution of mediastinal LN.

Patient underwent Robotic RPLND, tolerated procedure well. Discharged on Post op day 4 in stable condition. Histopath shows, Aorto-caval: 3 lymph nodes identified, free of tumor (0/3). Left common iliac: 2 lymph nodes identified, free of tumor (0/2). Left paraaortic: 2 nodal mass, each measuring 4.5x3 & 4x2.5 cm; Teratoma, post pubertal type (60-70%), Therapy related changes seen in the form of necrosis, cholesterol clefts, sheets of foamy histiocytes and hyalinization. No seminomatous component seen •No Extra-nodal extension. We have completed 8 cases with one conversion and rest had accelerated recovery and reduced morbidity as compared to open surgery.

Robotic RPLND is a feasible and minimal invasive surgery with early postoperative recovery and minimal morbidity, with good early oncological outcome.