Single-Port Robot-Assisted Post-Chemotherapy Unilateral Retroperitoneal Lymph Node Dissection: feasibility and surgical considerations

Retroperitoneal lymph node dissection (RPLND) is indicated for testicular cancer patients with residual masses after chemotherapy or for those with clinical stage I-II nonseminomatous germ cell tumors (NSGCT). While open RPLND remains the standard, it is associated with significant morbidity. Robotic-assisted RPLND (rRPLND) has emerged as a minimally invasive alternative, with the Da Vinci Single Port (SP) platform further advancing this approach.

We report a case of SP-rRPLND using a lower anterior approach (LAA) in a 41-year-old patient with a 3.5 cm residual retroperitoneal mass post-chemotherapy. The procedure was successfully completed without complications, with a console time of 79 minutes and minimal blood loss. The patient resumed oral intake on the first postoperative day, reported no pain at discharge, and was discharged on postoperative day two without complications.

This case represents, as far as we know, the first reported SP-rRPLND using LAA in Europe. The technique proved feasible and safe, facilitating access to the retroperitoneal space while preserving key anatomical structures. While SP-rRPLND offers advantages in perioperative recovery, challenges related to instrument triangulation remain. Further studies are needed to validate oncological outcomes and optimize surgical technique for broader clinical application.