The surgical approach to retroperitoneal lymph node resection involves a lateral paramedian incision in the midclavicular line. The three layers of the anterolateral abdominal wall (external oblique, internal oblique, and transversus abdominis) are opened and the transversalis fascia is divided. The next structure the surgeon sees is the parietal peritoneum. Instead of entering the parietal peritoneum, which is standard procedure for most intraabdominal operations, the surgeon gently pushes the parietal peritoneum toward the midline, which moves the intraabdominal contents and allows a clear view of the retroperitoneal structures. On the left, the para-aortic lymph node group is easily demonstrated, with a clear view of the abdominal aorta and kidney. On the right the inferior vena cava is demonstrated and has to be retracted to access the right para-aortic lymph node chain.