Robotic video endoscopic inguinal lymphadenectomy (R-VEIL) for vulvar cancer with sentinel node mapping using indocyanine green and near-infrared fluorescence imaging technology

Abstract

Video endoscopy inguinal lymphadenectomy (VEIL) has emerged as the new frontier for the surgical staging of vulvar cancer (VC) [1, 2]. In this surgical film we show a step-by-step video presentation of a Robotic SLNmapping using ICG (Canadian Task Force classification III). Although the therapeutic benefit of SLN remains controversial in clinical N0 (cN0) with VC N 4 cm [3], it provides prognostic information that can guide further adjuvant treatment. Robotic sentinel lymphnode (SLN) mapping using indocyanine green (ICG) appears to be a suitable and attractive alternative to provide reliable staging with respect to other tracers [3, 4]. A 75-year-old severely obesewoman (BMI:47.8 kg/m2) with squamous VC grading 3, clinical stage II (cT = 5 cm, cN0, cM0) and with a pre-operative PET-CT scan negative for metastatic localizations, was admitted for surgery. Surgical staging was performed including radical vulvectomy with macroscopic resection margins larger than 2 cm., SLN mapping with ICG followed by systematic inguinal lymphadenectomy. Da Vinci Xi System® was used to perform it. The operation was performed successfully with no intraoperative or postoperative complication. Operative time was 310 min overall. Twenty-five inguinal lymph nodes were removed (11 on the left, 14 on the right). The pathology report came back positive for SLN removed. The patient was discharged on day #4 and 20 days later started adjuvant radiochemotherapy. SLN with ICG is robotically feasible. However, we notice that further prospective trials are needed to compare ICG with other colorimetric and/or radioactive tracers in this subset of patients.