V8-01: Robotic RPLND Using the daVinci Xi
VideoIntroductions and Objectives
Robotic retroperitoneal lymph node dissection (RPLND) has been described for the treatment of testicular cancer using the da Vinci Si. Because the procedure requires dissection from the renal hilum to the inguinal canal, the da Vinci Si has previously required re-docking for complete removal of the spermatic cord. Recently the da Vinci Xi surgical platform has been introduced to allow multi-quadrant surgery without the need for re-docking. The Xi also allows for side docking of the robot which facilitates a variety of trocar placements and patient positions. The improved access and versatility of the da Vinci Xi could be applied to patient’s undergoing robotic RPLND. The purpose of this video is to demonstrate robotic RPLND, including patient positioning and port placement, using the da Vinci Xi surgical platform.
The da Vinci Xi was used to perform a robotic, right-sided template RPLND with a nerve sparing approach on a 46-year-old male with stage IA NSGCT. The patient was placed supine with arms tucked and in slight trendelenberg position. An angled linear port configuration was used to align the ports from the right lower quadrant towards the left costal margin with the 12 mm assistant port placed in the left lower quadrant. Approximately 7 cm was placed between the robotic ports and the robot was side docked on the patient’s right side.
A right-sided template dissection was performed with nerve sparing of the post-ganglionic fibers with the template. The paracaval, retrocaval, interaortocaval and para-aortic lymph nodes were removed. The spermatic cord was excised completely from the great vessels to the cord stump in the inguinal canal. The daVinci Xi allowed dissection from the renal hilum to the inguinal canal without the need for re-docking or additional port placement. Compared to previous supine RPLND using the daVinci Si, the da Vinci Xi resulted in better access to the retroperitoneum with no external arm conflict or internal limitation.
The da Vinci Xi facilitated robotic RPLND by allowing unhindered access from the renal hilum to the inguinal canal without the need for re-docking or additional ports. Robotic RPLND with the daVinci Xi decreased arm conflict and permitted side docking thereby allowing more complex procedures to be performed in the future.