Robot-assisted retroperitoneal lymph node dissection in testicular cancer: state of the art and future perspectives

Robot-assisted retroperitoneal lymph node dissection (R-RPLND) is an increasingly adopted minimally invasive option for carefully selected patients with testicular germ-cell tumours. We performed a narrative (non-systematic) review of retrospective single- and multicentre cohorts from high-volume programmes to appraise peri-operative safety, functional preservation, and oncologic control in primary and post-chemotherapy settings. In primary disease (typically clinical stage I–IIA/B), representative medians across series from expert centres include estimated blood loss of ~ 50 to 200 mL, hospital stay of 1–2 days, and nodal yields of ~ 19 to 32; major complications (Clavien–Dindo ≥ III) are uncommon (~ 0 to 10%), and antegrade ejaculation is usually preserved (often ≥ 85 to 100%) when nerve-sparing templates are applied. In post-chemotherapy cohorts—generally limited to smaller, peripherally located residual masses with favourable biology—robotic RPLND is feasible but technically demanding, with reported conversion rates of ~ 0 to 13% and major complication rates of ~ 10 to 20%; chylous complications remain a notable risk. Across available retrospective comparative series, including propensity-matched cohorts, R-RPLND has been associated with lower estimated blood loss and shorter hospitalisation than open RPLND (for example, ~ 200 vs 300 mL and 1 vs 5 days in a matched primary cohort; ~ 235 vs 825 mL and 2 vs 7 days in post-chemotherapy series), at the cost of longer operative time, while nodal yields and short-term oncologic outcomes appear comparable; these non-randomised data are descriptive and subject to selection and centre bias rather than proof of causality. For carefully staged seminoma IIA/B (≤ 3 cm nodes), contemporary guidelines permit RPLND as a chemotherapy-sparing option (Moderate recommendation; Evidence Level B), consistent with phase II data showing high 2–3-year disease control after primary RPLND. Centralisation and experience are critical: population-based analyses suggest fewer in-hospital complications and shorter hospital stays with robotic cases, and learning-curve data show improving efficiency and safety as programmes mature. Overall, when undertaken by experienced teams in high-volume centres, R-RPLND offers low blood loss, short hospitalisation, favourable ejaculatory outcomes, and low in-field recurrence for appropriately selected patients, while requiring judicious case selection and a low threshold for conversion in technically demanding post-chemotherapy disease.