Abstract
BackgroundTo investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy.MethodsA retrospective study was performed on clinical data from 19 patients with penile cancer admitted from March 2013 to October 2017. Among them, nine patients underwent robot-assisted laparoscopic antegrade inguinal lymphadenectomy (robot-assisted group) and 10 patients underwent open inguinal lymphadenectomy (open group). In the robot-assisted group, preoperative preparation, patient position, robot placement, design of operating channel and establishment of operating space are described. Key surgical procedures and techniques are also summarized. In addition, the number of lymph nodes removed, postoperative complications and follow-up in both groups were statistically analyzed.ResultsFor the 9 patients in the robot-assisted group, surgery was successfully accomplished at 17 sides without intraoperative conversion to open surgery. The surgery time for each side was 45~90 min using laparoscope with an average of 68.5 ± 13.69 min/side. The intraoperative blood loss was estimated to be < 10 ml/side, and the number of removed lymph nodes was not significantly different from that of the open group (12 ± 4.2/side vs.11 ± 5.8/side, P = 0.84). There were no postoperative complications such as skin necrosis, delayed wound healing and cellulitis in the robot-assisted group. Skin-related complications occurred in 9 (45%) of the 20 sides in the open group. During a median follow-up of 25 months in robot-assisted group and 52.5 mouths in open group, was not significantly different there were no statistical differences in recurrence-free survival between the groups (75% vs 60%, p = 0.536).ConclusionRobot-assisted laparoscopic antegrade inguinal lymphadenectomy achieved the desired surgical outcomes with fewer intraoperative and postoperative complications. The robotic arms of the surgical system were placed between the lower limbs of each patient. There was no need to re-position the robotic arms during bilateral inguinal lymphadenectomy. This simplified the procedure and reduced the use of trocars. If necessary, pelvic lymphadenectomy could be performed simultaneously using the original trocar position.
Highlights
To investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy
Da Vinci robot-assisted laparoscopic antegrade inguinal lymphadenectomy was successfully performed in nine patients from August 2016 to October 2017, obtaining satisfactory efficacy, which we report in this study
From the number of lymph nodes removed by surgery and the follow-up status, robotic-assisted laparoscopic antegrade inguinal lymphadenectomy was a safe and effective surgical method and was superior to traditional open surgery in terms of postoperative complications
Summary
To investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy. Penile cancer is a relatively rare genitourinary malignancy. Regional lymph node metastasis is considered to associate closely with the patient prognosis. Inguinal lymphadenectomy is an important treatment strategy for penile cancer. The efficacy of open inguinal lymphadenectomy is definite, the incidence rates of postoperative complications such as skin necrosis and delayed wound healing are about 50% [2, 3]. Many of the shortcomings of simple laparoscopic surgery are addressed using the da Vinci robotic system. Da Vinci robot-assisted laparoscopic antegrade inguinal lymphadenectomy was successfully performed in nine patients from August 2016 to October 2017, obtaining satisfactory efficacy, which we report in this study
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