In Reply.—I agree with Dr Barnhouse's observations. Retroperitoneal lymph node dissections for testicular tumor entail complete mobilization of the aorta and vena cava from renal pedicles to the bifurcations. Clearing of only one of the common iliacs and ipsilateral sympathectomy may be associated with normal erectile function. This has also been the experience of my own colleagues in urology.
In avoiding dissection and division of the inferior mesenteric artery, I have taken into account the extreme variability of origin of this vessel. It is frequently with a few centimeters of the aortic bifurcation. As Dr Barnhouse recognized, it is important to preserve one nerve plexus about the common iliac artery. This probably is the left one; it is important to note that both neural anatomy as well as location of the inferior mesenteric origin vary. My reason for suggesting preservation of the inferior mesenteric artery is that this step
DEPALMA RG. Preservation of Erectile Function-Reply. Arch Surg. 1979;114(2):226. doi:10.1001/archsurg.1979.01370260116024
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.