Editing Retroperitoneal Lymph Node Dissection (section)

== Use of modified template RPLND ==

* The relatively predictable pattern of the lymphatic spread of testicular GCTs provided strong pathologic evidence for the use of “modified bilateral” templates in patients with low-stage retroperitoneal disease.
*Potential advantages:
** Decreased risk of loss antegrade ejaculation (from omission of the contralateral retroperitoneum and interiliac regions) 
** Decreased risk of chylous ascites, renovascular injuries, and pancreatic complications (from omission of suprahilar regions)
* Boundaries of the modified template vary by definition.
** At Indiana, the recommended template for right‐sided tumours included the paracaval, precaval, inter‐aortocaval, pre‐aortic, right iliac and right gonadal regions. The template for left‐sided tumours included the para‐aortic, pre‐aortic, inter‐aortocaval, left iliac and left gonadal regions. Ultimately, Indiana’s '''modified templates eliminated dissection of the contralateral tissue below the inferior mesenteric artery, thereby sparing the lumbosacral sympathetic nerves, postsympathetic efferent nerves, and hypogastric sympathetic plexus'''.
* '''Suprahilar/retrocrural and interiliac resections can safely be omitted from the standard RPLND template.''' However, controversy exists regarding the need to resect the contralateral retroperitoneal lymphatic tissue.
* The standard PC-RPLND is resection of all macroscopic disease along with a full bilateral infrahilar dissection.