Medical Oncologist
CION Cancer Clinics
Laparoscopic and robotic RPLND | CION Cancer Clinics
Keyhole RPLND, with or without robotic help, is the same operation done through several small cuts instead of one long one. A small number of large centres in India offer it. It usually suits men with small, well-defined disease, often before any chemotherapy, in the hands of a surgeon who does it regularly. Open surgery remains common after chemotherapy. This page explains who each approach suits and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Is robotic or keyhole RPLND available in India, and does it suit you?
- How does open RPLND compare with keyhole or robotic RPLND?
- Who might be offered a keyhole or robotic operation, and who is not?
- What happens during a keyhole or robotic RPLND?
- What do families assume about robotic RPLND that is not quite right?
- What should you ask a centre offering robotic RPLND?
- What can this page not tell you?
- Common questions about laparoscopic and robotic RPLND
The short answer
Is robotic or keyhole RPLND available in India, and does it suit you?
Yes, a small number of large centres in India offer RPLND through keyhole cuts, some with robotic help. It is the same operation, done through several small openings instead of one long cut. It suits selected men, mostly those with small, well-defined disease, in the hands of a surgeon who does this operation regularly.
What changes, and what does not
The template, meaning the map of nodes removed, should be the same whether the operation is open or keyhole. So should the care taken over the nerves for ejaculation. What changes is the way in. With keyhole surgery, a camera and long thin instruments go through small cuts. With robotic surgery, the surgeon sits at a console and moves the instruments through robotic arms.
Why open surgery is still common
RPLND works around the body's largest artery and vein. After chemotherapy, scar tissue can glue nodes to those vessels. In that situation many surgeons feel an open operation gives safer control if bleeding starts. The approach should follow the disease, not the other way round.
This page does not suggest that any particular centre, including CION, offers robotic RPLND. Ask your own team what they provide.Side by side
How does open RPLND compare with keyhole or robotic RPLND?
Open RPLND
Keyhole or robotic RPLND
One long cut down the middle of the abdomen
Several small cuts, each for a camera or instrument
Usually a longer hospital stay and slower return to work
Often a shorter stay and a quicker return to normal life
Suits large masses and most operations after chemotherapy
Suits mainly small, well-defined disease in selected men
Offered by most surgical oncology centres that do RPLND
Offered by far fewer centres, and usually costs more
Not sure whether this applies to you?
Ask an oncologistSuitability
Who might be offered a keyhole or robotic operation, and who is not?
Your team decides on the basis of your scans, your history and their own experience. These are the patterns they usually weigh.
More likely to be offered
Men having a primary RPLND, done without chemotherapy first, where the nodes are small or not visibly enlarged.
Often also
- Disease on the expected side
- No earlier abdominal surgery
Sometimes considered
Men after chemotherapy with a small, clearly defined leftover mass that is not stuck to the major vessels, at centres with a lot of experience in this exact operation.
Usually not suitable
Men with bulky masses, masses wrapped around the main artery or vein, disease above the kidney vessels, or a mass that has grown during or after chemotherapy.
Other reasons against it
Heavy scarring from earlier surgery, some heart or lung conditions that make a long operation with gas in the abdomen harder, or a team without regular experience of it.
Inside the operation
What happens during a keyhole or robotic RPLND?
Anaesthesia and position
You are fully asleep. You are placed on your side or flat with your head tilted down, so the bowel falls away from the area being cleared.
Small cuts and gas
The surgeon makes several small cuts and fills the abdomen with gas. This creates space to see and work. The camera shows a magnified view on a screen.
Clearing the nodes
The nodes are lifted off the large vessels within the planned template. Where planned, the nerves for ejaculation are found and protected.
Removing the tissue
The nodes are placed in a bag and brought out through one of the cuts, then sent to the laboratory for testing.
Changing to open if needed
If bleeding or scar tissue makes keyhole work unsafe, the surgeon changes to an open cut. Agree to this in advance. It is a safety step, not a failure.
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Commonly believed
What do families assume about robotic RPLND that is not quite right?
"The robot does the operation."
The surgeon does every movement. The robotic system steadies and scales the surgeon's hand movements and gives a magnified three-dimensional view. The result depends on the surgeon's skill and experience, not on the machine.
"Robotic surgery removes the cancer more completely."
There is no clear proof that it removes more disease than open surgery. The studies so far come mostly from specialist centres and follow men for limited periods. What matters most is that the full planned template is cleared.
"Small cuts mean a small operation."
The work inside is the same major operation near the largest blood vessels. The outside wounds heal faster, but the risks inside, such as bleeding, lymph leaks and bowel slowness, still apply.
"If our city does not have it, we must travel for it."
Only if it suits the disease. For many men an open operation by an experienced local team is the right choice. Travel adds cost and makes follow-up harder, so ask whether keyhole surgery would actually change anything in your case.
Take this to clinic
What should you ask a centre offering robotic RPLND?
- How many RPLNDs does this surgeon do each year, open and keyhole?
- Will the template be the same as in an open operation?
- How often do you have to change to an open cut?
- Will you try to spare the nerves for ejaculation?
- What will my insurance or scheme cover for the robotic part?
- Who follows me up afterwards, and where?
Honest limits
What can this page not tell you?
It cannot tell you whether keyhole or robotic surgery suits you. That depends on the size and position of your disease, whether you have had chemotherapy, and how much experience the team in front of you has with this operation.
The evidence is still growing
Most published results on robotic RPLND come from a small number of expert centres. They show shorter stays and faster recovery in selected men. Long-term comparisons with open surgery are still limited, so be careful with any claim that one approach is clearly superior.
Cost and cover
Robotic surgery usually adds charges for the machine and its instruments. Aarogyasri, CGHS, ECHS, EHS and cashless insurance policies treat those charges differently, and some cap them. Ask for a written estimate and check it against your cover before you decide. Cost is a fair reason to choose an open operation when both are suitable.
Questions we are asked
Common questions about laparoscopic and robotic RPLND
Is laparoscopic RPLND the same as robotic RPLND?
Both are keyhole operations through small cuts. In laparoscopic surgery the surgeon holds long instruments directly. In robotic surgery the surgeon controls the instruments from a console, with a magnified view and wristed movement. The operation inside, and the template of nodes removed, should be the same.
Does robotic RPLND hurt less?
Small cuts are usually less sore than one long cut, and many men need less pain relief and move sooner. You will still have discomfort, and shoulder ache from the gas is common for a day or two. Your team will plan pain relief for either approach.
Can robotic RPLND be done after chemotherapy?
In selected men, at centres with a lot of experience. After chemotherapy, scar tissue often sticks nodes to the large vessels, which makes keyhole work harder and riskier. Many surgeons prefer an open operation in that situation. Ask your team how your scans affect this choice.
Is ejaculation more likely to be kept with robotic surgery?
Not simply because of the robot. Ejaculation depends on the template and on whether the nerves can be spared. The magnified view may help some surgeons see the nerves, but an experienced open surgeon can spare them too. Ask about nerve-sparing directly, whatever approach is planned.
What happens if the surgeon has to switch to open?
The operation continues through a larger cut. Your recovery will be closer to that of an open RPLND, with a longer stay. Surgeons change to open when it is safer, for example to control bleeding. You will be asked to agree to this possibility before the operation.
Does insurance cover robotic RPLND in India?
It varies. Some policies cover robotic surgery in full, some cap it, and some government schemes pay only a fixed package amount. Ask the hospital for a written estimate and ask your insurer or scheme office what they will pay before you choose.
Will I go home sooner after keyhole RPLND?
Often, yes, if the operation goes as planned and your bowel starts working quickly. The exact stay depends on your recovery, not on the approach alone. Plan for a family member to stay with you for the first days at home, whichever operation you have.
Should we travel to another city for robotic surgery?
Only if it would change your care. First ask your own team whether keyhole surgery suits your disease. If it does and they do not offer it, ask for a referral. Remember that follow-up scans and blood tests continue for years, so think about where those will happen.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- American Cancer Society — Surgery for Testicular Cancer
- National Cancer Institute — Testicular Cancer Treatment (PDQ) - Health Professional Version
- Cancer Research UK — Testicular cancer: treatment
- Cancer.Net — Testicular Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
RPLND: what the operation involvesThe operation itself, whichever way it is doneTemplates: full bilateral vs modifiedThe map of nodes that should not change with the approachPrimary vs post-chemotherapy RPLNDWhy chemotherapy makes keyhole surgery harderRPLND cost and where it is done in IndiaWhat drives the bill and what schemes coverChoosing a surgeon and a centreQuestions that matter more than the machine
Talk to us
Wondering whether keyhole surgery fits your case?
Call the helpline or send us your scans. A surgical oncologist will explain what your reports suggest and help you frame the questions to ask any centre. One helpline serves every CION centre.