Robotic Supine RPLND Human Fresh Frozen Cadaver Course

Date: 1 April 2023, Saturday

Venue: RMK AIMES Surgical Training & Convention Center, Istanbul

Course Summary

Retroperitoneal lymph node dissection (RPLND) is a surgical procedure applied for testis tumor when indicated. Due to the low numbers of robotic RPLND operations, it is difficult for surgeons to gain experience. Herein, we present the result of the very first time used human fresh frozen cadaver model for robotic RPLND course performed on April 1st, 2023 at RMK AIMES Surgical Training Center in Istanbul.

We used a torso human fresh frozen cadaver that was previously used. A Da Vinci x 4-arm surgical robot (Intuitive) was used. We had one proctor and two trainees.

A total of 5 ports were placed, 4 robotic ports on the transverse line 4 cm below the umbilicus, and 1 assistant (Airseal) port on the right side 2 cm distal to this line.  Right ureter-iliac artery crossing was identified. Peritoneal incision was made along the right ilac artery parallel to the root of mesointestinum up to Treitz ligament, without mobilizing the caecum. Ileum was lifted by suturing peritoneal flap underneath to abdominal wall on both sides. Fourth robotic arm was used to lift duedonum and pancreas up during dissection. Ureters, vena cava, aorta, nerve bundles; renal, testicular and lumbar arteries and veins were identified.

Lymphatic tissues were completely removed within the following limits: renal veins (upper border), ureters (lateral border), iliac arteries (inferior border), inter-aorta-caval, para-aortic, para-caval areas. Retrocaval and retroaortic dissections were done by moving these structures laterally. Inferior mesenteric artery was severed for left sided dissection..

Our model for robotic RPLND training is very effective and could increase the experience of a novice surgeon considerably. Minimally invasive robotic supine RPLND technique is a reasonable approach which may be offered to cT1 and cT2 testicular cancer patients for accurate staging and treatment.  Prevention of unnecessary prophylactic chemotherapy may decrease its short and long term complications. Major advantages of supine RPLND are it permits both bilateral dissection and also faster access to the field if emergency switch to open surgery is needed due to vascular injury without repositioning, preparing and draping the patient.