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Full bilateral and modified RPLND templates, compared | CION Cancer Clinics
A template is the map of lymph nodes your surgeon removes. A full bilateral template clears both sides of the large blood vessels at the back of the abdomen. A modified template clears mainly the side where the affected testicle drains, which leaves more of the ejaculation nerves untouched. The choice depends on how much disease there is, where it sits, and whether you have had chemotherapy. This page explains both. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between a full bilateral and a modified template?
- How do the two templates compare?
- Which templates might your surgeon talk about?
- Who is a modified template suitable for, and who is it not?
- What do families misunderstand about RPLND templates?
- What should you ask about your template?
- What can this page not tell you?
- Common questions about RPLND templates
The short answer
What is the difference between a full bilateral and a modified template?
A template is the map of which lymph nodes the surgeon removes. A full bilateral template clears nodes on both sides of the large blood vessels at the back of the abdomen. A modified template clears only the side where the affected testicle drains first, which leaves the nerves on the other side untouched.
Why the testicle decides the side
The testicles develop high in the abdomen before birth and move down later. Their lymph channels still drain back up to nodes near the kidneys. A right testicle drains first to nodes around the large vein on the right. A left testicle drains first to nodes beside the main artery on the left. That predictable pattern is what makes a one-sided operation possible.
What the choice actually trades
A larger field removes more nodes that might hold disease. A smaller field disturbs fewer of the nerves that control ejaculation. Neither template is simply better. Each suits a different amount and spread of disease, and your surgeon weighs your scans, your blood markers and any chemotherapy you have had before choosing.
The template is decided before the operation, but the surgeon may widen it if the findings on the day call for it.Side by side
How do the two templates compare?
Full bilateral
Modified (one-sided)
Nodes cleared on both sides of the main artery and vein
Nodes cleared mainly on the side the testicle drains to
Higher chance that ejaculation changes, unless both sides are nerve-spared
Nerves on the untouched side are left alone, so ejaculation is kept more often
Often used after chemotherapy when disease was large or on both sides
Often used when disease is small and sits where it is expected
A longer operation over a wider area
A shorter operation, though still a major one
The maps surgeons use
Which templates might your surgeon talk about?
You may hear these names in clinic or see them on the operation note. The exact borders vary a little between surgeons.
Right modified
For a right testicle. Clears nodes around the large vein and in the space between the vein and the artery, down to where the vessels split towards the right leg.
Left modified
For a left testicle. Clears nodes beside and in front of the main artery on the left, down to where it splits towards the left leg.
Full bilateral
Clears both of the above together, from the level of the kidney blood vessels down to where the vessels split towards the legs, and across from one ureter to the other.
The ureters are the tubes that carry urine from each kidney.The cord stump, on every template
On the affected side, the surgeon also removes the remaining blood vessel that once ran to the testicle. It can carry disease, so it goes with the nodes whichever map is chosen.
Not sure whether this applies to you?
Ask an oncologistHow the choice is made
Who is a modified template suitable for, and who is it not?
A modified template is usually considered when the disease is small, sits on the side where the testicle drains, and the scans show nothing beyond it. Many primary operations, done without chemotherapy first, fall into this group.
When a full template is more likely
Surgeons tend to choose the full bilateral map when nodes were large before chemotherapy, when disease crossed to the other side, or when a mass sits somewhere unexpected. After chemotherapy, scar tissue also makes it harder to be sure where live disease might remain, and many teams prefer the wider field for that reason.
Who a modified template does not suit
It does not suit men with bulky disease, disease on both sides, a mass outside the expected drainage area, or markers that suggest spread further up. For them, a smaller operation may leave disease behind, and that risk outweighs the gain for ejaculation.
What is still debated
For some men after chemotherapy with a small, well placed mass, expert centres disagree. Studies comparing the two approaches over many years are limited. If your team has chosen one template, it is reasonable to ask why, and what would have made them choose the other.
Commonly believed
What do families misunderstand about RPLND templates?
"A bigger operation always means a safer result."
Removing nodes where disease is very unlikely adds time and nerve risk without adding much protection. The aim is to match the field to where disease is likely to be. That is why the smaller map exists at all.
"A modified template means the surgeon is cutting corners."
It is a planned choice based on how testicular cancer spreads. It is used for men whose scans and markers fit a known pattern. It still needs the same skill and care as the full operation.
"With a full template, ejaculation is always lost."
Not always. Surgeons can often find and protect the nerves on both sides, even in a full bilateral operation. Whether that is possible depends on how much disease and scar tissue surrounds them.
"We can ask for the smaller operation to protect fertility."
You can and should ask about it. But the template has to fit the disease first. If a smaller field is not suitable, sperm banking before surgery is the more reliable way to protect fertility.
Take this to clinic
What should you ask about your template?
- Which template is planned for me, and why that one?
- What would make you widen it during the operation?
- Will you try to spare the nerves, and on which side?
- Should I bank sperm before the date?
- Has my case been discussed at a tumour board?
- Will the operation note say which nodes were removed?
Honest limits
What can this page not tell you?
It cannot tell you which template is right for you. That depends on your scans, your markers, what the testicle showed under the microscope, and whether you have had chemotherapy. Only your treating team has all of those in front of them.
The template is not the whole story
The same map can be done open, through small keyhole cuts, or with robotic help, and with or without nerve-sparing. Each of those is a separate decision. A good conversation with your surgeon covers all three, not only the template.
If you want another opinion
It is reasonable to ask for your scans and reports to be reviewed by another surgical team before a major operation. Bring the scan images on a disc, not only the written reports, so that the reviewing surgeon can see the nodes for themselves.
Questions we are asked
Common questions about RPLND templates
What does template mean in RPLND?
It is the planned area the surgeon clears of lymph nodes. The borders are the kidney blood vessels above, the point where the main vessels split towards the legs below, and the ureters at each side. A template can cover both sides or mainly one side.
Is a modified RPLND a smaller operation?
It covers a smaller area, so it usually takes less time and disturbs fewer nerves. It is still a major operation in the abdomen, with a hospital stay and a recovery period. The difference from the full template is mostly in the nerve risk rather than in how you feel afterwards.
Will a modified template protect my ejaculation?
It makes normal ejaculation more likely, because the nerves on the untouched side are left alone. It is not a promise. Disease close to the nerves on the operated side can still affect them. Ask your surgeon what they expect in your case, and think about banking sperm beforehand.
Can the surgeon change the template during surgery?
Yes. If the surgeon finds nodes that look involved outside the planned area, they may widen the field. This is usually discussed with you before the operation. Ask what would lead them to do it, so the operation note does not come as a surprise afterwards.
Why do some doctors prefer full bilateral after chemotherapy?
After chemotherapy, scar tissue can hide where live disease or teratoma remains, and disease is more often found outside the expected side. A wider field lowers the chance of leaving some behind. Some expert centres use modified templates for carefully selected men, and this is still discussed.
Does the template change the recovery time?
A little, in most cases. A smaller field usually means a shorter operation. The bigger differences in recovery come from whether the operation is open or keyhole, and whether you had chemotherapy first. Your team will give you a recovery plan that fits the operation you actually have.
Where will I find which template was used?
In the operation note and in the pathology report, which lists the groups of nodes that were sent to the laboratory. Ask for copies of both. Keep them with your scans, because any doctor who follows you up later will want to know exactly what was removed.
If my nodes were only on one side, why clear both?
Sometimes small deposits exist that scans cannot show, especially when disease was large or after chemotherapy. Your surgeon may judge that the chance of disease on the other side is high enough to clear it. Ask them to explain what in your scans or markers led to that choice.
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Sources
- National Cancer Institute — Testicular Cancer Treatment (PDQ) - Health Professional Version
- National Cancer Institute — Testicular Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for Testicular Cancer
- Cancer Research UK — Testicular cancer: treatment
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
Nerve-sparing RPLND and ejaculationHow the nerves are protected within either templatePrimary vs post-chemotherapy RPLNDWhy chemotherapy changes the template decisionLaparoscopic and robotic RPLNDThe separate choice of how the template is doneFertility after RPLNDSperm banking and options if ejaculation changesChoosing a surgeon and a centreWhat to look for before a major operation
Talk to us
Not sure why a template was chosen?
Call the helpline or send us your scans and reports. A surgical oncologist will go through the plan with you and help you frame your questions for your own team. One helpline serves every CION centre.