Editing Retroperitoneal Lymph Node Dissection (section)

== Anatomic principles of RPLND[https://pubmed.ncbi.nlm.nih.gov/31059667/] ==

* '''<span style="color:#ff0000">Relevant anatomy</span>'''
**'''Lumbar vessels[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412119/]'''
***See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412119/figure/F1/ Figure]
***'''Arteries'''
****'''Four, paired branches'''
*****'''2nd–4th pairs commonly encountered below the level of the left renal vein'''
****'''Regularly spaced'''
***'''Veins'''
****'''Variable, unpaired vessels''' 
****'''Preferentially drain into the left-posterior side of the IVC'''
****Positioned at a distance from one another that segmentally increases closer to the iliocaval confluence 
**Aortic plexus[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412119/]
***Supplied by at least two lumbar splanchnic nerves on each side
***Composed of two parallel nerves (cords), each containing two major ganglia
*'''<span style="color:#ff0000">Template</span>'''
** '''<span style="color:#ff0000">Full bilateral template</span>'''
*** '''<span style="color:#ff0000">The boundaries of a full bilateral template include</span>'''
**** '''<span style="color:#ff0000">Superiorly: the crura of the diaphragm</span>''' '''and skeletonized renal vessels'''
**** '''<span style="color:#ff0000">Inferiorly: the bifurcation of the common iliac arteries/crossing of the ureter over the ipsilateral common iliac artery</span>'''
**** '''<span style="color:#ff0000">Laterally: the ureters</span>'''
**** This area includes the primary and secondary landing zones of the right (paracaval, interaortocaval) and the left (paraaortic, preaortic) testicle.
*** '''A full, bilateral template includes removal of the (10):'''
***# '''Para-aortic'''
***# '''Retro-aortic'''
***# '''Pre-aortic'''
***# '''Left common iliac'''
***# '''Interoartocaval'''
***# '''Pre-caval'''
***# '''Para-caval'''
***# '''Retro-caval'''
***# '''Right common iliac lymph nodes'''
***# '''Ipsilateral gonadal vessels'''
*** '''<span style="color:#ff0000">Indications (2019 AUA Guidelines)[https://pubmed.ncbi.nlm.nih.gov/31059667/]</span>'''
**** '''<span style="color:#ff0000">Absolute (2):</span>'''
****# '''<span style="color:#ff0000">Suspicious lymph nodes based on CT imaging or intraoperative assessment</span>'''
****# '''<span style="color:#ff0000">Somatic-type malignancy in the primary tumor.</span>'''
****#* Malignant transformation of teratoma is defined as the transformation of a somatic teratomatous component of a germ cell tumor (GCT) to a non-germ cell malignant tumor[https://pubmed.ncbi.nlm.nih.gov/31781458/]. Examples of most common malignant transformation are sarcoma (e.g., rhabdomyosarcoma, osteosarcoma, chondrosarcoma, angiosarcoma, and liposarcoma), carcinoma (adenocarcinoma and squamous cell carcinoma), primitive neuroectodermal tumor, as well as hematologic malignancies[https://pubmed.ncbi.nlm.nih.gov/24908364/].
**** '''Relative'''
***** '''Clinically negative lymph nodes.'''
** '''Modified'''
*** '''Right modified template may omit the para-aortic lymph nodes below the inferior mesenteric artery.'''
**** Omission of para-aortic lymph nodes above the inferior mesenteric artery is controversial.
*** '''Left modified template dissection may omit paracaval, precaval, and retrocaval lymph nodes.'''
**** Omission of interaortocaval lymph nodes is controversial.
*** '''Indications'''
**** '''Relative'''
***** '''Clinically negative lymph nodes.'''
** '''A complete retroaortic and/or retrocaval lymph node dissection with division of lumbar vessels should be performed when within the planned template.'''
** '''The ipsilateral gonadal vessels should be removed in all patients.'''
**