{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:11:59Z","timestamp":1778857919531,"version":"3.51.4"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006034","name":"University of Southern California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006034","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Retroperitoneal lymph node dissection remains a critical operation in selected patients with testicular cancer, including defined settings of early metastatic disease, post-chemotherapy residual masses, and emerging indications for primary retroperitoneal lymph node dissection in low-volume seminoma. Despite advances in minimally invasive surgery, this operation remains technically demanding because of its proximity to the great vessels, renal hilum, lumbar branches, ureters, and sympathetic neural structures. To present a standardized stepwise technical guide for robotic retroperitoneal lymph node dissection, emphasizing reproducible exposure, peritoneal flap suspension, nerve-aware dissection, posterior plane development, controlled vascular and lymphatic management. This technical report describes robotic retroperitoneal lymph node dissection as a sequential operative workflow. Key steps include patient positioning, port placement, mesenteric incision, creation of a broad L-shaped peritoneal flap, bilateral flap suspension, cephalad stay sutures, entry into the retroperitoneal template, early neural identification, split-and-roll dissection, posterior-first interaortocaval development, and selective clip-based control of vascular and lymphatic branches. The patient is positioned supine in Trendelenburg to facilitate bowel displacement. A broad peritoneal flap is developed and suspended to maintain durable exposure. Dissection proceeds using fixed anatomic landmarks, beginning with controlled access to stable avascular planes. Sympathetic fibers are identified early when nerve preservation is oncologically appropriate. Interaortocaval and para-aortic dissection are performed using a posterior-first strategy to improve orientation and permit deliberate management of lumbar vessels. Mechanical clip control is favored for lymphatic channels and higher-risk vascular branches. Robotic retroperitoneal lymph node dissection can be performed as a structured operation centered on exposure, orientation, neural preservation, posterior plane development, and selective vascular control. Standardization may improve technical clarity during this complex retroperitoneal procedure.<\/jats:p>","DOI":"10.1007\/s11701-026-03470-x","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:25:00Z","timestamp":1778855100000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic retroperitoneal lymph node dissection: a stepwise technical guide"],"prefix":"10.1007","volume":"20","author":[{"given":"Willy","family":"Bacaglini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P.","family":"Dugarte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Eskenazi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio A.","family":"Bianco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Calderon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Guevara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arie","family":"Carneiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Sibanto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rene J.","family":"Sotelo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis G.","family":"Medina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"3470_CR1","doi-asserted-by":"crossref","unstructured":"Stephenson A, Bass EB, Bixler BR et al (2024) Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. J Urol","DOI":"10.1097\/JU.0000000000003694"},{"key":"3470_CR2","doi-asserted-by":"crossref","unstructured":"Daneshmand S, Cary C, Masterson TA et al (2023) Surgery in Early Metastatic Seminoma: A Phase II Trial of Primary Retroperitoneal Lymph Node Dissection. J Clin Oncol","DOI":"10.1200\/JCO.22.00624"},{"key":"3470_CR3","doi-asserted-by":"crossref","unstructured":"Giona S (2022) The epidemiology of testicular cancer. Urologic Cancers. Exon","DOI":"10.36255\/exon-publications-urologic-cancers-epidemiology-testicular-cancer"},{"issue":"7","key":"3470_CR4","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1111\/j.1464-410X.2009.08888.x","volume":"105","author":"SB Williams","year":"2010","unstructured":"Williams SB, McDermott DW, Winston D et al (2010) Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int 105(7):918\u2013921","journal-title":"BJU Int"},{"key":"3470_CR5","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12957-020-02032-1","volume":"18","author":"CG Ruf","year":"2020","unstructured":"Ruf CG, Krampe S, Matthies C et al (2020) Major complications of post-chemotherapy retroperitoneal lymph node dissection in a contemporary cohort of patients with testicular cancer and a review of the literature. World J Surg Oncol 18:253","journal-title":"World J Surg Oncol"},{"issue":"1","key":"3470_CR6","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.aju.2012.01.001","volume":"10","author":"JH Hillelsohn","year":"2012","unstructured":"Hillelsohn JH, Duty BD, Okhunov Z, Kavoussi LR (2012) Laparoscopic retroperitoneal lymph node dissection for testicular cancer. Arab J Urol 10(1):66\u201373","journal-title":"Arab J Urol"},{"key":"3470_CR7","doi-asserted-by":"crossref","unstructured":"Ghoreifi A et al (2025) Oncological Outcomes Following Robotic Postchemotherapy Retroperitoneal Lymph Node Dissection for Testicular Cancer: A Worldwide Multicenter Study. Eur Urol","DOI":"10.1016\/j.euf.2024.11.001"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03470-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03470-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03470-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:25:03Z","timestamp":1778855103000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03470-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3470"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03470-x","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"assertion":[{"value":"13 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"506"}}