case_images: PMC10642947_01
case_images: Gray arrow indicates the direction of traction of the transverse mesocolon (1). White arrow indicates the traction of the first jejunal loop (2) to achieve correct exposure of the inferior vena cava (3) and the aorta (4).
case_images: 0102-6720-abcd-36-e1772-gf01.jpg
case_images: PMC10642947_01_0102-6720-abcd-36-e1772-gf01.jpg
case_images: f1
case_images: Dissection begins with the release of the duodenojejunal angle, which allows the mobilization of the 4th portion of the duodenum to the right and exposure of the anterior wall of the inferior vena cava and the infrarenal aorta (Figure 1).
case_images: Gray arrow indicates the incision of the retroperitoneal anterior to the aorta. It begins usually at the level of the inferior mesenteric artery (1) and extends cranially until the left renal vein (2) is identified and fully exposed. A latero-aortic infrarenal lymph node is harvested (3).
case_images: 0102-6720-abcd-36-e1772-gf02.jpg
case_images: PMC10642947_01_0102-6720-abcd-36-e1772-gf02.jpg
case_images: f2
case_images: The incision over the retroperitoneum anterior to the aorta provides exposure of the anterior aortic wall. The extension of the retroperitoneal incision cranially allows the left renal vein to be identified and fully exposed, which marks the upper limit for the aortocaval space dissection (Figure 2).
case_images: Incision of the retroperitoneal anterior to the inferior vena cava. Dissection of the interaortocaval nodes (*) begins (white arrow) at the level of the inferior mesenteric artery (1) and extends cranially to the inferior border of the left renal vein (2).
case_images: 0102-6720-abcd-36-e1772-gf03.jpg
case_images: PMC10642947_01_0102-6720-abcd-36-e1772-gf03.jpg
case_images: f3
case_images: We use surgical clips and LigaSure  to obtain hemostasis and lymphostasis (Figures 3 and 4).
case_images: Final aspect of the surgical field after para-aortic lymph nodes sampling.
case_images: 0102-6720-abcd-36-e1772-gf04.jpg
case_images: PMC10642947_01_0102-6720-abcd-36-e1772-gf04.jpg
case_images: f4
case_images: We use surgical clips and LigaSure  to obtain hemostasis and lymphostasis (Figures 3 and 4).