Name:
Bilateral Nerve-sparing Robotic-assisted Retroperitoneal Lymph Node Dissection: A Minimally Invasive Approach
Description:
Bilateral Nerve-sparing Robotic-assisted Retroperitoneal Lymph Node Dissection: A Minimally Invasive Approach
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/789670f1-7637-4727-88f2-f087a2ad9776/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=0V21k4QwXKZSrNV2409yupAlxaAGsO41wXoQRViA4rg%3D&st=2025-04-26T00%3A32%3A28Z&se=2025-04-26T04%3A37%3A28Z&sp=r
Duration:
T00H08M51S
Embed URL:
https://stream.cadmore.media/player/789670f1-7637-4727-88f2-f087a2ad9776
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/789670f1-7637-4727-88f2-f087a2ad9776/Robotic RPLND.mp4?sv=2019-02-02&sr=c&sig=GyawWl6ps0rIG%2BuoHzE6iK6vod7ebiNemZGWKBRUQZc%3D&st=2025-04-26T00%3A32%3A28Z&se=2025-04-26T02%3A37%3A28Z&sp=r
Upload Date:
2023-12-06T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 Introduction.
SPEAKER: We present the surgical steps and surgical considerations for a robotic retroperitoneal lymph node dissection. We begin by incising the posterior peritoneum,
Segment:2 Mobilization of the Colon.
SPEAKER: inferior and medial to the cecum, approximately at the level of the terminal ilium.
SPEAKER: A posterior peritoneal flap is raised and dissected cephalad towards the renal hilum. The posterior peritoneal incision is carried across the midline until the inferior mesenteric vein is visualized. This reflection is then sutured to the anterior abdominal wall in two points using a 2-0 Prolene suture.
Segment:3 Formation of the Hammock.
SPEAKER:
SPEAKER: The sutures are tensioned appropriately to facilitate exposure to the retroperitoneum.
Segment:4 Identification of Dissection Borders.
SPEAKER: The dissection is taken cephalad until the renal hilum is identified. Here, we identified the left renal vein.
SPEAKER: Large lymphatic vessels are clipped inferior to the renal hilum to help minimize lymphatic leak. We begin our dissection by splitting and rolling
Segment:5 ParaCaval/ Precaval Lymph Node dissection.
SPEAKER: along the inferior vena cava. It is important to dissect onto the adventitia layer directly to minimize bleeding and facilitate dissection.
SPEAKER:
SPEAKER: The paracaval packet is then reflected laterally using a combination of cautery and blunt dissection. The interaortocaval lymph node packet is then dissected.
SPEAKER: We utilize a robotic vessel sealer to help control the lumbar vessels. Care must be taken during this step to prospectively identify post-ganglionic sympathetic efferent fibers that course posterior to the IBC and anterior to the aorta. This will help preserve antegrade ejaculation We again split and roll over the anterior aorta to facilitate dissection.
SPEAKER: Care must be taken during this step to avoid the inferior mesenteric artery.
SPEAKER: Following this split and roll, the interaortocaval packet is then completely dissected. Again, we see the superior aspect at the level of the renal hilum. We complete our dissection by rolling off the periaortic lymph nodes laterally.
SPEAKER: Again, attention should be paid to identification of the inferior mesenteric artery as it typically courses in this direction.
SPEAKER: Depending on the location of the primary testicular malignancy, the ipsilateral common iliac lymph nodes are dissected inferiorly to the level of the iliac bifurcation or the urethral crossing.
Segment:6 Spermatic Cord Dissection.
SPEAKER: We complete our dissection by ligating the gonadal vein.
SPEAKER: The distal extent is ligated as close to the internal ring as possible. After the dissection template is complete, careful attention is turned towards hemostasis and identification of any lymphatic leak.
SPEAKER:
