Endoscopic Inguinal Lymphadenectomy Research Articles

Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes

Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes

Preferring Lateral Video Endoscopic Inguinal Lymph Node Dissection Over Classic Video Endoscopic Inguinal Lymph Node Dissection in Squamous Cell Carcinoma of Penis: Lessons Learnt from Twenty-One Patients at a Single Center.

Inguinal lymphadenectomy is essential for staging and disease control. Minimally invasive techniques are recently replacing open techniques to reduce complications. We present our experience and lessons learnt from 21 patients who underwent lateral video endoscopic inguinal lymphadenectomy (L-VEIL) for penile malignancy. All patients above 18 years of age with histopathology-confirmed squamous cell carcinoma penis with stages ≥ T1b and T1a with persistent lymphadenopathy who underwent L-VEIL over a period of 2 years (2020-2022) were included. The data were analyzed on the basis of intraoperative and postoperative complications, lymph node yield, hospital stay, and histopathology report. Forty-one lower limbs of 21 patients underwent L-VEIL during the abovementioned period. Median age was 52 years. Mean operative time (on 1 side) was 80 minutes. Median lymph node yield per side was 7.2. Intraoperatively, 1 patient had a vascular injury at the saphenofemoral junction, requiring conversion to open. Postoperative complications were superficial surgical site infection (n=4), lymphedema (n=1), and lymphocoele (n=3), one of which was drained by pigtail catheter. One patient required exploration on the second postoperative day because of vascular injury. Average duration of hospital stay was 3 days. The median time of drain removal was 13 days. Histopathology suggested seminoma in 1 patient and mature teratoma in 1 patient; the rest of the patients' reports were negative for malignancy. The L-VEIL is safe and feasible, and there is a reduction (~30%) in complications; oncological outcomes are also not affected. It has better ergonomics, resulting in ease and comfort for surgeons when compared with classical VEIL.

Long-term follow-up of comparative study of open and endoscopic lymphadenectomy in patients with penile carcinoma.

Penile carcinoma is an uncommon cancer that develops in the penis tissue. The standard surgical method to manage regional lymph nodes after local excision is radical inguinal lymphadenectomy, but it has a high rate of complications. The objective of this retrospective study was to compare the long-term outcomes of endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy in patients with penile carcinoma. The study included patients diagnosed with penile carcinoma who underwent open inguinal lymphadenectomy (n = 23) or endoscopic inguinal lymphadenectomy (n = 27) at a single hospital between January 2013 and January 2021. Operation time, blood loss, drainage, hospital stay, postoperative complications, and survival rates were assessed and compared between the two groups. The two groups were comparable in terms of age, tumor size and stage, inguinal lymph nodes, and follow-up. The endoscopic group had significantly lower blood loss (27.1 ± 1.5ml vs 55.0 ± 2.7ml, P < 0.05), shorter drainage time and hospital stay (4.7 ± 1.1 days vs 8.1 ± 2.2days, and 13.4 ± 1.0 days vs 19 ± 2.0days, respectively, P < 0.05), and longer operation time compared to the open group (82.2 ± 4.3min in endoscopic group vs 53.1 ± 2.2min in open group, P < 0.05). There were significant differences in the incidence of incisional infection, necrosis, and lymphorrhagia in both groups (4 vs 0, 4 vs 0, and 2 vs 0, respectively, P < 0.05). The inguinal lymph node harvested was comparable between the two groups. The mean follow-up time was similar for both groups (60.4 ± 7.7m vs 59.8 ± 7.3m), and the recurrence mortality rates were not significantly different. The study shows that both open and endoscopic methods work well for controlling penile carcinoma in the long term. But the endoscopic approach is better because it has fewer severe complications. So, the choice of surgery method might depend on factors like the surgeon's experience, what they like, and what resources are available.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer.

To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

MP33-12 COMPARING PERIOPERATIVE OUTCOMES AFTER ROBOT ASSISTED VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY (RAVEIL) WITH OPEN INGUINAL LYMPH NODE DISSECTION (O-ILND) USING PROPENSITY SCORE MATCH ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP33-12 COMPARING PERIOPERATIVE OUTCOMES AFTER ROBOT ASSISTED VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY (RAVEIL) WITH OPEN INGUINAL LYMPH NODE DISSECTION (O-ILND) USING PROPENSITY SCORE MATCH ANALYSIS Sheshang Kamath, Abhinav Veerwal, Akash Shah, and Thyavihally Yuvaraja Sheshang KamathSheshang Kamath More articles by this author , Abhinav VeerwalAbhinav Veerwal More articles by this author , Akash ShahAkash Shah More articles by this author , and Thyavihally YuvarajaThyavihally Yuvaraja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the advent of robot, the indications for performing robot assisted surgery in urology have been expanding. Although open inguinal lymph node dissection (O-ILND) still remains the gold standard for management of inguinal lymph nodes in carcinoma of penis, the post-operative complications, time to drain removal and lymphocoele formation remain a drawback even in high volume centers. In this study, we intend to compare these perioperative parameters of (O-ILND) with RAVEIL using propensity score match analysis (PSM). METHODS: This study is retrospectively analyzed from a prospectively maintained cancer registry of the oncology department in our tertiary care institute. The data was obtained between 2008 and July 2022 from a single center operated by a single surgeon to avoid surgeon and institution bias. Patients with incomplete data set and no follow up for at least 3 post-operative months were excluded from the study. Univariate analysis was performed for baseline parameters, pathologic and perioperative outcomes among the two groups using Chi square test for categorical variables and student t-test was used for continuous variables. Multivariate logistic regression analysis was then performed. Propensity score match analysis (PSM) 1:1 was used to independently evaluate postoperative complications of Clavien dindo grade 3 and above and time to drain removal and skin complications after matching for the patient and pathologic characteristics. The value of p considered significant was <0.05. Statistical analysis were performed using SPSS version 23 and propensity score match analysis was performed using XLSTAT. RESULTS: Among 86 patients, 154 inguinal node dissections (68 O-ILND and 86 RAVEIL) were performed. Median age of patient was 60 (IQR 54-62) in O-ILND and 58 (IQR 56-61) in RAVEIL. Most common tumor stage for both arms was T2 (68.2 % in O-ILND vs 71% in RAVEIL) and most common grade was poorly differentiated (56.2 % in O-ILND vs 48.6% in RAVEIL). The operative time among both groups was comparable (100 minutes in O-ILND vs 92 minutes in RAVEIL) Perioperative factors significantly improved among RAVEIL group was preservation of saphenous vein, Clavien Dindo complications 3 or more and skin complications. PSM 1:1 done for 64 inguinal node dissections matched for baseline patient and pathologic variables found Clavien Dindo complications 3 or more and skin complications to be significantly lesser in the RAVEIL group. CONCLUSIONS: Although few previous studies in recent years have already mentioned the non-inferior oncologic outcomes and lesser morbidity with RAVEIL, this study is the first to our knowledge which uses PSM to match patient and tumor characteristics and thereby identify specific benefits of RAVEIL statistically. This study can also be used as a platform for a larger multi centric evaluation prospective analysis and thereby broaden the application of RAVEIL in near future. Source of Funding: We have no source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e454 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sheshang Kamath More articles by this author Abhinav Veerwal More articles by this author Akash Shah More articles by this author Thyavihally Yuvaraja More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluating the perioperative outcomes of the novel technique of using ICG dye with firefly technology in robot assisted video endoscopic inguinal lymphadenectomy (ICG-RAVEIL): Our initial experience of 25 consecutive cases

Evaluating the perioperative outcomes of the novel technique of using ICG dye with firefly technology in robot assisted video endoscopic inguinal lymphadenectomy (ICG-RAVEIL): Our initial experience of 25 consecutive cases

Linfadenectomía inguinal videoendoscópica modificada por abordaje suprafascial: descripción de la técnica y resultados quirúrgicos preliminares

IntroductionThe videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients. Patients and methodsA single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors. ResultsA total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10mL (range 10-25). Mean operative time was 115 minutes (range 120-170). Median number of nodes removed was 10.25 (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48hours but ranged from 24-96hours within the series. ConclusionsThe modified Video Endoscopic Inguinal Lymphadenectomy (VEIL) technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy.

Modified Video Endoscopic Inguinal Lymphadenectomy: a Deep-First Approach

ObjectiveTo describe our modified technique of performing video endoscopic inguinal lymphadenectomy (VEIL) with the proposed benefits of a shallow learning curve and better ergonomics. MethodsWe describe our modified VEIL technique: the deep first approach, in a squamous cell carcinoma penis patient with a pathological T3 disease and bilateral palpable, mobile inguinal lymph nodes post penectomy. ResultsThe surface markings and the port incision sites for the procedure were conventional. However, in contrast to the standard superficial dissection plane development below the Scarpa's fascia at the initial camera port site, our technique commenced with a deep dissection plane just above the fascia lata. The dissection limits were directly identified: the sartorius muscle laterally, the inguinal ligament superiorly, and the adductor longus muscle medially. The saphenous vein was identified early and close to the saphenofemoral junction, allowing undemanding dissection. The superficial flap dissection was done entirely under direct vision, with better ergonomics owing to a continuous counter-traction by the pressure of insufflated gas. Deep inguinal nodal dissection then concluded the procedure. ConclusionThe described technique is surmised to be easier to perform, given the lack of ambiguity in the correct initial dissection plane, direct visualization of surgical landmarks early in the procedure, and early identification of the saphenous vein close to the SFJ. It may improve the learning curve allowing for a wider acceptance of VEIL.

Minimal invasive approaches in lymph node management of carcinoma of penis: A review.

Introduction:Inguinal lymph node dissection (ILND) is an integral part in the management of carcinoma penis. The concerns about the postoperative morbidity associated with open ILND led to modification in the template of dissection and adoption of minimally invasive techniques such as video endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL (R-VEIL). In this review, we aim to describe the techniques, case selection, perioperative outcomes, and oncological outcomes of VEIL and R-VEIL and to compare it with open ILND.Methods:Databases of PubMed, Embase, and Google Scholar were searched to identify the articles for VEIL and R-VEIL. Using PRISMA guidelines, literature search yielded 3783 articles, of which 32 full-text articles relevant to the topic were selected and reviewed, after consensus from authors.Results:After the first description of VEIL, various modifications in port placements and approaches were described. Several studies have shown, VEIL and R VEIL are safe and feasible in both node-negative and node-positive Ca penis patients. Compared to open ILND, VEIL had fewer wound infections and skin necrosis, minimal blood loss, shorter mean hospital stays, and reduced duration of drain kept. There is no difference in mean lymph node yield and recurrence rates between open ILND, VEIL, R-VEIL.Conclusion:VEIL and R-VEIL are safe and have comparable oncological outcomes with open ILND.

Video Endoscopic Inguinal Lymphadenectomy in Post Saphenous Vein Graft Harvest (Coronary Artery Bypass) Status

Video Endoscopic Inguinal Lymphadenectomy in Post Saphenous Vein Graft Harvest (Coronary Artery Bypass) Status

Comparison of the two routes of video endoscopic inguinal lymphadenectomy in vulvar cancer: a systematic review and a single-center experience.

BackgroundVideo endoscopic inguinal lymphadenectomy (VEIL) has fewer complications than open surgery for vulva cancer. No high-level evidence comparing the efficacy and safety of the two routes of VEIL (VEIL-H and VEIL-L) is available.MethodsWe performed a comprehensive literature search for reports on VEIL for vulva cancer from 2000 to 2020 and reviewed our experience. Data extraction includes patients’ characteristics, perioperative indicators, postoperative complications, and cancer recurrence.ResultsA total of 11 eligible studies were included in the systematic review. Nine studies included only one route of VEIL, and the other two studies directly compared the two routes of VEIL. The average operation time of the VEIL-L group was 85 (range, 33–180.12) minutes, and that of the VEIL-H group was 112 (range, 35–170.79) minutes. The average blood loss of the VEIL-L group was 9 (range, 5–30) mL, and that of the VEIL-H group was 96 (range, 5.5–214.8) mL. The average number of intraoperatively removed lymph nodes in the VEIL-L group was 9 (range, 7.5–13.2), and that in the VEIL-H group was 14 (range, 9.5–16). No significant difference was observed in the cancer recurrence rate between the two groups. We found similar results in our cohort study.ConclusionsThe operation time, intraoperative blood loss, and time of drainage of the VEIL-L procedure seemed less than those of the VEIL-H procedure. VEIL-L and VEIL-H were equivalent in the efficacy of lymph node dissection, surgery-related complications, and cancer recurrence rate.

Safety and feasibility of single-incision radical vulvectomy: a novel approach for the treatment of vulvar cancer.

BackgroundIn the process of decreasing the morbidity of wound-related complications after vulvectomy and IL for treating vulvar malignancy, we performed a novel surgical procedure—single-incision radical vulvectomy (SIRV). Here, we share our initial experience and report its safety and feasibility.MethodsPatients with advanced local vulvar tumors were sequentially enrolled in this prospective cohort study to undergo SIRV. While performing SIRV, routine radical vulvectomies were performed first. Subsequently, the flaps of the bridge area between the vulvectomy incisions and femoral triangles were separated and the lymph nodes underneath were removed. Anterior working spaces (AWS) before the femoral triangle were then made. The saphenous vein was carefully identified and retained, while the superficial and deep inguinal lymph nodes were removed from the medial to the lateral sides. After careful hemostasis, the wounds were sutured. Patient demographics, clinical data, pathologic data, operation time, node count, and complications were recorded.ResultsTen patients underwent SIRV for vulvar cancer. Average hospital stay was 11.70±3.16 (range, 9–13) days. The average number of harvested lymph nodes was 7.59±3.62 (range, 3–15) and 15.14±3.63 (range, 11–20) for per side or both sides of the groin. Blood loss was ≤35 mL. Three patients developed inguinal lymphoceles and underwent needle aspirations. Two patients had impaired wound healing and achieved healing after dressing change. No other postoperative complications were noted during follow-up.ConclusionsCompared with conventional open inguinal lymphadenectomy (COIL) and video endoscopic inguinal lymphadenectomy (VEIL), SIRV is a more minimally invasive procedure. Our short-term observations showed that SIRV is safe and feasible and has good future application prospects for vulvar cancer. However, definitive conclusions cannot be made. Therefore, long-term oncologic outcomes and large-scale clinical trials are warranted.

Port Site Squamous Cell Carcinoma Following Video Endoscopic Inguinal Lymphadenectomy

Port site metastasis is one of the feared complications following laparoscopic oncosurgery. We present the case report of port site recurrence following video endoscopic inguinal lymphadenectomy (VEIL) for carcinoma penis. A 54-year-old gentleman had undergone total penectomy with bilateral videoendoscopic inguinal lymphadenectomy 2 years back. Histopathology was reported as well-differentiated squamous cell carcinoma. Fifteen nodes on the right side and 8 nodes in the left were found negative for tumour. Ten months later, he presented with an indurated swelling in right mid-thigh with serous discharge at the site of camera and extraction port of VEIL. Core needle biopsy was done and reported as moderately differentiated squamous cell carcinoma. PET CT was done, and no other sites of activity were seen. Hence, wide local excision of the lesion with local rotation flap cover was done. Right iliac lymphadenectomy was done. The histopathology confirmed negative margins. Twelve iliac lymph nodes were negative for tumour. He received 3 cycles of cisplatin-based chemotherapy. This is the first case report of port site recurrence of squamous cell carcinoma following VEIL. The probable mechanisms are pneumatic spread or spill during extraction. The possibility of second primary should also be considered, due to negative lymph nodes in first biopsy. Port site recurrence is a rare but definite possibility following VEIL. Precautions should be taken like preventing air leak, using extraction bag and avoiding trocar slip to decrease the incidence of port site recurrence.

Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis

Open inguinal lymph node dissection (O-ILND) is the gold standard in the management of lymph nodes in carcinoma penis; however, video endoscopic inguinal lymphadenectomy (VEIL) is performed in some centers. Our primary objective is to compare perioperative and survival outcomes in patients undergoing VEIL with O-ILND, as very few studies have reported long-term survival outcomes till date. We analyzed patients who underwent O-ILND and VEIL (laparoscopic or robot-assisted) from January 2009 to January 2020 in our institute for carcinoma of the penis. Patient details, perioperative complications, and survival outcomes were analyzed. Perioperative outcomes were analyzed by logistic regression and survival outcomes by log-rank and Cox regression methods. We analyzed 79 patients (32 O-ILND, 47 VEIL) with a median follow-up of 51(IQR 25.5-75.5) and 42months (IQR 21-62). Wound complications were common in O-ILND group (65.6%) compared to VEIL group (27.7%) (p = 0.001), predominantly skin flap necrosis in 14 groins (23.73%) after O-ILND and none after VEIL. Median overall survival was 80 and 88months (p = 0.840) with five-year survival of 65% and 66.8% (p = 0.636) and five-year DSS of 76.6% and 73.9% (p = 0.96) in O-ILND and VEIL, respectively. Multivariate analysis showed that grade and pathological node status were significant (HR-2.650, p = 0.040; HR-3.218, p = 0.024) factors for survival. The retrospective nature of the study design is the limitation. Management of inguinal lymph nodes in carcinoma penis by VEIL is safe, associated with lesser wound-related complications, and equivalent survival outcomes compared to O-ILND. It should be considered as an alternative option for inguinal lymph node dissection.

Laparoscopic and robotic video endoscopic inguinal lymphadenectomy by the lateral approach.

Video endoscopic inguinal lymphadenectomy (VEIL) improves on open inguinal node dissection because it offers decreased morbidity. In conventional VEIL, port placement is along the long axis of the femur, above the knee joint. In the laparoscopic approach, this placement is fraught with problems because the camera hits the knee, the surgeon must reach over the camera, and sword fighting occurs between the instruments. In the robotic approach, external collisions are likewise not uncommon because of a lack of optimal spacing between the robot's arms. Here, we describe our lateral approach technique that can be used for both laparoscopic and robotic platforms and can help solve the problems presented by conventional VEIL. A retrospective review was performed to examine the records of all patients who had undergone VEIL at our institution for management of squamous cell carcinoma of the penis. Patients who had undergone lateral VEIL were identified. The clinical factors, surgery details, time to discharge and drain removal, postoperative complications, and nodal pathology were recorded. A total of 30 VEILs-26 laparoscopic and 4 robotic-were performed by the lateral approach. On clinical examination, none of the patients had clinically palpable nodes. The mean operative time on one side was 100 minutes (range, 80-140 minutes). The blood loss was minimal in all cases, and there were no conversions to open procedures. The mean time to drain removal was 7 days (range, 5-12 days). Two patients developed bilateral lymphoceles. Lateral VEIL is feasible and can be used as an alternative to conventional VEIL.

P113 - Comparative study of perioperative and survival outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) and Open Inguinal Lymph Node Dissection (OILND) in the management of inguinal lymph nodes in carcinoma penis

P113 - Comparative study of perioperative and survival outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) and Open Inguinal Lymph Node Dissection (OILND) in the management of inguinal lymph nodes in carcinoma penis

Utility of Intraoperative Fluorescence Imaging in Gynecologic Surgery: Systematic Review and Consensus Statement.

This study aimed to review the current knowledge on the utility of intraoperative fluorescence imaging in gynecologic surgery and to give evidence-based recommendations to improve the quality of care for women who undergo gynecologic surgery. A computer-based systematic review of the MEDLINE, CENTRAL, Pubmed, EMBASE, and SciSearch databases as well as institutional guidelines was performed. The time limit was set at 2000-2019. For the literature search, PRISMA guidelines were followed. A modified-Delphi method was performed in three rounds by a panel of experts to reach a consensus of conclusions and recommendations. Indocyanine green (ICG) is used primarily in gynecology for sentinel node-mapping. In endometrial and cervical cancer, ICG is a feasible, safe, time-efficient, and reliable method for lymphatic mapping, with better bilateral detection rates. Experience in vulvar cancer is more limited, with ICG used together with Tc-99m as a dual tracer and alone in video endoscopic inguinal lymphadenectomy. In early ovarian cancer, results are still preliminary but promising. Indocyanine green fluorescence imaging also is used for ureteral assessment, allowing intraoperative ureteral visualization, to reduce the risk of ureteral injury during gynecologic surgery. For most gynecologic cancers, ICG fluorescence imaging is considered the tracer of choice for lymphatic mapping. The use of this new technology expands to a better ureteral assessment.

Prospective Evaluation of Video Endoscopic Inguinal Lymphadenectomy vs Conventional Inguinal Lymphadenectomy in Carcinoma of the Penis

Singh, Harvinder MBBS, MS, MCh; Kumar Pal, Ajay MBBS FACS; Kumar, Awanish MBBS, MS Author Information

Inguinal lymph node dissection in the era of minimally invasive surgical technology.

Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications. The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000-2020. There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes.