Robotic para-aortic lymph node dissection via the left renal vein as the starting point

Preoperative chemotherapy combined with gastrectomy and radical surgery may be useful in patients with gastric cancer and metastasis-positive para-aortic lymph nodes. Although robotic surgery is considered useful in difficult cases because it provides highly magnified three-dimensional high-definition images of anatomical views and precise techniques, a meticulous approach for para-aortic lymph node dissection (PALND) is important. We typically perform PALND via the left renal vein at our institution. Robotic PALND was performed in six patients from April 2018 to July 2024. The median total operative time and volume of blood loss were 552 (271-634) min and 316 (75-771) mL, respectively. The time required for dissection of No. 16b1-int and No. 16a2-lat was 68 (65-103) min and approximately 30 min, respectively. All six patients underwent rapid postoperative treatment, including postoperative chemotherapy. A clear understanding of the relevant anatomy, beginning with the left renal vein, should result in a safe and reliable robotic surgical approach for PALND.