Non-seminomatous germ cell tumours (NSGCTs) are aggressive malignancies that commonly affect young men. Radical orchiectomy is the standard treatment for localised disease followed by adjuvant chemotherapy for high-risk cases, and surveillance for low-risk cases. Following Bleomycin, Etoposide and Cisplatin (BEP) chemotherapy, only 6%-10% of residual masses contain active cancer, 50% of which have post-pubertal teratoma and 40% have necrotic-fibrotic tissue only. Resection is mandatory in all patients with a residual mass greater than 1cm in greatest diameter at cross-sectional imaging. Retroperitoneal lymph node dissection (RPLND) is a surgical procedure that is indicated for patients with NSGCTs with residual masses or positive lymph nodes even after chemotherapy, or for those with stage-II or -III disease at presentation. RPLND is associated with significant morbidity, including retrograde ejaculation, erectile dysfunction, and vascular injuries. Robot-assisted RPLND (RA-RPLND) is a minimally invasive surgical technique that has gained popularity in recent years. This approach allows for improved visualisation and access to the retroperitoneal lymph nodes, reduced blood loss, and shorter hospital stay compared to open surgery. Additionally, RA-RPLND has been associated with lower rate of postoperative complications, such as wound infections and ileus. The use of the Da Vinci Surgical System has made RA-RPLND a feasible option for patients with NSGCTs with high success rates and low morbidity. In this case study, we present a patient with NSGCT who underwent successful RA-RPLND along with right pelvic lymph node dissection using a common port position with no postoperative complications. Case Study A 23-year-old male presented to Medanta - Gurugram with a diagnosis of NSGCT of the right testis. He had undergone right high inguinal orchidectomy in November 2022, and histopathology revealed embryonal cell carcinoma. He received 4 cycles of chemotherapy with the BEP regimen in his home country, with the last cycle completed in February 2023. The patient's post-chemotherapy Alpha-fetoprotein (AFP) was 3.82ng/mL, and human chorionic gonadotropin (HCG) was less than 0.5mIU/mL. The patient had no comorbidities at the time of presentation. His haemoglobin was 12.9g/dl and serum creatinine was 1.3mg/dl. Positron emission tomography - computed tomography (PET-CT) scan was done and was compared to the PET-CT scan done in the previous year. It was suggestive of partial response with reduction in size, number and Fluorodeoxyglucose (FDG) uptake of the metastatic lymph nodes in aortocaval, common and external iliac regions. Present findings included enlarged external iliac lymph node (1.5cmx1cm), common iliac lymph node (1cmx1cm) and a nodal mass (3cmx4cm) in the interaortocaval region just below the renal vessels. There was an absence of FDG avid disease in the rest of the regions surveyed. The patient was planned for Robotic RPLND with right pelvic lymph node dissection using a common port position. Intraoperatively, the patient was first placed in a low lithotomy position. Docking of Da Vinci Si robot was done in lithotomy position for the right pelvic lymph node dissection first. Six ports, including three 8mm, two 12mm, and one 5mm port were inserted keeping in mind the use of common ports for RPLND part of the procedure with camera port placed below the umblicus. There was an intense pelvic desmoplastic reaction seen along the nodes due to chemotherapy. Right pelvic lymph node dissection was done. The right gonadal vein was identified and dissected distally up to the silk suture ligature at the stump of the spermatic cord. The right external, internal, and common iliac group of lymph nodes were dissected and removed. The robot was then redocked from above the left shoulder using the same ports. Only one extra assistant port was needed for RPLND, which was placed in right iliac fossa. Bilateral common iliac vessels, aortic bifurcation and the right ureter were identified. An incision was made over posterior peritoneum at the root of mesentry. Dissection was continued in cephalad direction in continuation with proximal extent of right common iliac node dissection. Great vessels were identified and cut along the edge of the peritoneum; overlying small bowel was retracted towards anterior abdominal wall using fourth arm and multiple nylon stay sutures. These stay sutures were passed through anterior abdominal wall using straight needle and after passing through peritoneal edge, the sutures were taken back out and anchored using artery forceps. The paracaval, retrocaval, precaval, interaortocaval, preaortic, and paraaortic lymph nodes were then dissected. Traction on stay sutures was sequentially increased from outside the abdominal wall as the dissection progressed cranially. This helped in not only increasing the space for retroperitoneal dissection but also formed a mesh preventing the small bowel from obstructing the surgical field. The right renal vein, left renal vein, and bilateral renal arteries were identified defining the upper limit of dissection. The right gonadal vein was dissected until its origin on IVC and was clipped and divided. The lateral limit was defined by bilateral ureters. Complete bilateral RPLND and right pelvic lymph node dissection was achieved robotically. No drain was placed. The abdomen was desufflated, and the specimen was retrieved from the assistant port. The ports were removed under vision, and the port sites closed. The total intraoperative time was 4 hours with a blood loss of 100ml. The patient was discharged from the hospital on Day 2 after surgery and the post-operative course was uneventful. The histopathology revealed 35 lymph nodes, all free of tumour. Conclusion Our case highlights the technical nuances, intraoperative meticulous steps and robotic expertise that needs to be followed in a major surgery of this kind to prevent devastating complications. This case also highlights the challenges of robot-assisted RPLND in a patient with NSGCT who had received chemotherapy previously. RA-RPLND offers several advantages over traditional open RPLND. The use of robotics allows for a faster recovery and more precise dissection of the retroperitoneal lymph nodes, potentially reducing the risk of damage to surrounding vital structures.