Editing Retroperitoneal Lymph Node Dissection (section)

== Pre-operative planning ==

* Patients who are candidates for RPLND should be referred to an experienced surgeon at a high-volume center.
** Surgeons with experience in the management of GCT and expertise in minimally invasive surgery may offer a minimally-invasive RPLND, acknowledging the lack of long-term data on oncologic outcomes with minimally-invasive approach.
*Principles of RPLND (template, limits, nerve-sparing, etc.) are applied, regardless of the intent to administer adjuvant chemotherapy or approach (open vs. minimally-invasive)
*'''Patients that have received bleomycin are at risk of post-operative respiratory distress syndrome'''; '''low fraction of inspired oxygen (FIO2) and conservative intraoperative fluid resuscitation are important in minimizing the risk of postoperative lung toxicity'''
** Based on two studies, one from 1978 of 12 patients undergoing RPLND for testis cancer at MSK[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1605498/] (used t-test for statistics), and another from 1998 of 77 patients with previous bleomycin exposure undergoing “major surgical procedures” at MD Anderson[https://pubmed.ncbi.nlm.nih.gov/9751352/]. The latter study found that in multivariate analysis, only amount of blood transfused, preoperative forced vital capacity and surgical time in descending order were significant. In univariate analysis, fluid balance, type of fluid given, among others were significant. Maintained intraoperative fractional inspired oxygen was not significant on either analysis.
* '''Identify renal arterial anatomy''' and possibility of accessory branches
*'''High-fat diet on night prior to surgery can facilitate identification of lymphatic vessels during surgery'''