Robot-assisted Inguinal Lymphadenectomy Research Articles

Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review.

Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL). On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement. Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients. The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.

Comparison of antegrade robotic assisted VS laparoscopic inguinal lymphadenectomy for penile cancer

BackgroundMinimally invasive modifications of inguinal lymphadenectomy (IL), including laparoscopic IL (LIL) and robotic-assisted IL (RAIL), have been utilized for penile cancer. Comparative study is necessary to guide the decision about which minimally invasive technique to select for IL. Therefore we compared RAIL with LIL performed via an antegrade approach in terms of perioperative outcomes.MethodsWe conducted a retrospective study of 43 patients who underwent RAIL (n = 20) or LIL (n = 23) for penile cancer from 2016 to 2020. The key surgical procedures and techniques are described. Complications were graded by the Clavien-Dindo classification, and operative time, estimated blood loss (EBL), lymph nodal yield, nodal positivity, postoperative drain duration, and disease recurrence during follow-up were assessed. Categorical variables were compared using chi-squared whereas continuous variables were compared by t-tests.ResultsThe operative time for RAIL was significantly shorter than that of LIL (median 83 vs 95 min). Significantly less blood loss was reported with RAIL than with LIL (median 10 vs 35 ml). Lymph node yield, pathological positive nodes, the hospital stay, postoperative drain duration, postoperative complications and recurrence were similar for RAIL and LIL.ConclusionsFor patients with penile cancer, perioperative outcomes of RAIL and LIL were similar, but there was less blood loss, a shorter operative time for robotic cases.

V11-11 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY FOR PENILE CANCER: STEP-BY-STEP TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V11-11 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY FOR PENILE CANCER: STEP-BY-STEP TECHNIQUE Alberto Piana, Josep Maria Gaya, Pietro Diana, Andrea Gallioli, Antonio Rosales, Pavel Gavrilov, Angelo Territo, Joan Palou, and Alberto Breda Alberto PianaAlberto Piana More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Pietro DianaPietro Diana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Antonio RosalesAntonio Rosales More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile cancer metastasis follows a well established predictable pattern, being not possible to have distant metastasis without positive inguinal nodes. Therefore, in penile cancer inguinal lymphadenectomy have diagnostic and therapeutic value. Despite robust evidences, many urologists still do not indicate this surgery. Centralization and minimally invasive techniques showed to improve oncological outcomes (overall survival and cancer specific survivor) and to decrease morbidity. METHODS: We present a clinical case of a 51 years old patient underwent robotic-assisted bilateral inguinal lymphadenectomy performed after previous glandectomy and Bracka reconstruction. Pathology showed squamous cell carcinoma pT2, negative margins, p16 negative and no palpable nodes on physical exam of the groin. Because of clinical staging cN0 and the high risk of metastasis, according to the EAU Guidelines, we performed robotic-assisted inguinal lymphadenectomy (RAIL). Da Vinci X system with 3 arms was used and an extra 5mm trocar for the assistant was placed. RESULTS: Surgical time was 210 min and EBL <50 mL. Final pathology was 8 negative nodes in the right groin and 8 negative nodes in the left groin. Drainages were removed after 3 weeks and no major complications were reported. CONCLUSIONS: RAIL is a safe technique with same oncological indications and outcomes with less morbidity and less morbidity compared to the open approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e924 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Piana More articles by this author Josep Maria Gaya More articles by this author Pietro Diana More articles by this author Andrea Gallioli More articles by this author Antonio Rosales More articles by this author Pavel Gavrilov More articles by this author Angelo Territo More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF DownloadLoading ...

Minimally invasive approaches to the inguinal nodes in cN0 patients.

In penile cancer, lymphadenectomy can have staging and possibly therapeutic values. However, many physicians and patients are reluctant when it comes to inguinal lymph node dissection (ILND) due to high rate of surgical morbidities. In recent years, minimally invasive surgical approaches have shown success in reducing perioperative morbidities. Newer surgical modalities, including videoscopic inguinal lymphadenectomy and robotic-assisted inguinal lymphadenectomy, have been explored to reduce the morbidities of ILND while not compromising oncologic outcomes. Data on this topic is limited but available data suggest that these minimally invasive techniques are safe and associated with less perioperative morbidities. There is no study to directly compare the oncological outcome between these different techniques. However, number of dissected lymph nodes is used a surrogate for oncologic outcomes. Different treatment approaches including open, laparoscopic, and robotic seem to be similar and effective in terms of nodal yield. Laparoscopic and robotic approaches are successful in dissecting inguinal lymph nodes and are associated with lower rate of major perioperative complications. Individual patient's characteristics as well as surgeon's experience should be considered when trying to decide the optimum surgical modality for ILND.

V8-09 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY: EARLY OUTCOMES AND TECHNICAL MODIFICATIONS

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2015V8-09 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY: EARLY OUTCOMES AND TECHNICAL MODIFICATIONS Alexander M. Helfand, Jeffrey S. Montgomery, Alon Z. Weizer, and Todd M. Morgan Alexander M. HelfandAlexander M. Helfand More articles by this author , Jeffrey S. MontgomeryJeffrey S. Montgomery More articles by this author , Alon Z. WeizerAlon Z. Weizer More articles by this author , and Todd M. MorganTodd M. Morgan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2133AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer with nodal metastases is associated with poor cancer-specific survival. Both resection of metastatic nodes and prophylactic removal of benign nodes provide durable survival advantages. Open inguinal lymph node dissection (ILND) is associated with a high rate of cutaneous and lymphatic complications, particularly skin flap necrosis. Endoscopic ILND prevents iatrogenic disruption of the inguinal skin's vascular supply, thus reducing the incidence of major complications. Our objective is to use video to describe our robotic-assisted inguinal lymphadenectomy (RAIL) technique and report early outcomes in both clinically node-negative and positive patients. METHODS We conducted 10 RAIL procedures in 6 patients with invasive penile squamous cell carcinoma from 2013-2014. Four patients received bilateral RAIL in the same setting and two had unilateral RAIL after contralateral open ILND. We stationed the robotic base directly over the midline at the patient's head and put the patient in moderate Trendelenburg to eliminate the need for intraoperative repositioning. The median post-operative follow-up period was 87 days (17-511). We classified complications as early (≤30 days) or late (31-90 days) and graded them by the Clavien Dindo classification system. RESULTS In our cohort, median age was 74.7 years (IQR 73-79), Charlson comorbidity index was 6 (5-12), and BMI was 36.1 kg/m2 (29-42). Per limb, median operative time was 157.5 minutes (137-182), blood loss was 25 mL (8-25), superficial nodal yield was 8 nodes (6-11), and time to drain removal was 24.5 days (20-27). There were no intraoperative complications. Median length of stay was 2 days (2-4). Two patients with clinically node-positive cancer had bilateral metastatic nodes (1.5 per limb (1-3)). All other patients had pN0 cancer. Clavien I-II complications occurred in 4 patients in 6 limbs (seroma, wound infection). One patient had a seroma requiring operative drainage (Clavien III). Early complications occurred in 6 limbs, and there was a late complication (seroma) in 1 limb. In follow-up, 2 patients had locoregional recurrence (1 died), and 1 had lung metastases. CONCLUSIONS RAIL is a safe procedure with similar nodal yield to open ILND, no intraoperative complications, and technical advantages for the surgeon. Postoperative complications are mostly minor and no skin flap necrosis was seen, yet surgical site complications remain problematic. Reducing the morbidity of RAIL and proving oncological efficacy will require continued investigation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e717-e718 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander M. Helfand More articles by this author Jeffrey S. Montgomery More articles by this author Alon Z. Weizer More articles by this author Todd M. Morgan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches.

Inguinal lymph node dissection is a diagnostic and potentially curative treatment for penile carcinoma, which has historically been associated with high morbidity rates. This review summarizes the initial outcomes of robotic-assisted inguinal lymphadenectomy (RAIL) compared with the outcomes of the standard open and endoscopic approaches. The early experience suggests that RAIL may yield comparable oncologic outcomes, although future prospective studies of RAIL with greater numbers of participants and long-term follow-up are needed to evaluate the incidence and severity of perioperative and postoperative complications.

Robot-Assisted Inguinal Lymphadenectomy for Urethral Carcinoma

Introduction: A 69-year-old female with a history of distal invasive urethral squamous cell carcinoma treated with distal urethrectomy was found to have an enlarged left inguinal node during surveillance 17 months after the operation. Positron emission tomography (PET)/computed tomography showed a 1.5 cm lymph node (LN), which displayed increased activity on PET. Biopsy of this lesion revealed a poorly differentiated squamous cell carcinoma. This video describes our technique for a robot-assisted inguinal lymphadenectomy. Methods: The patient was placed on the split leg table. A 2 cm incision was made down to fascia lata in the midthigh 18 cm inferior to the inguinal ligament. Blunt dissection was used to create this plane above fascia lata. A Hassan-type 10 mm trocar was placed through the 2 cm incision and insufflation to 15 mm Hg was initiated. Two robotic ports were placed under direct vision 8 cm on both sides of the camera port. A 10 mm assistant port was also placed between the camera and the lateral robotic ports. The DaVinci Si robot was docked, and fenestrated bipolar grasper and monopolar scissors were used throughout the case as dissecting instruments. The saphenous vein was identified and followed to its insertion into the femoral vein. The split and roll technique was used to remove lymphatic tissue around vessels. Weck and metallic clips were used for vascular and lymphatic control. Weck clips were used as there was adequate overlying adipose tissue and no concern for palpating these from the skin level. The boundary of the LN dissection was the inguinal ligament superiorly, adductor longus muscle medially, and sartorius muscle laterally. LNs from above and below fascia lata were sent separately as superficial and deep LN packets, respectively. Adequate hemostasis was ensured and a 15F Blake drain was placed through a robotic port site. Results: The robotic console time was 3.5 hours with minimal blood loss. There were no intraoperative complications. Postoperatively, she developed minimal lower extremity lymphedema managed with compression stockings. She was discharged home on postoperative day 2 (POD 2). The drain was removed in the clinic on POD 13. Final pathology revealed 1 out 10 LNs positive for metastatic squamous cell carcinoma. At 9 months of follow-up, she had no evidence of recurrent disease and had trace edema of the lower extremity. Conclusion: Robot-assisted inguinal lymphadenectomy can be performed safely for the treatment of distal urethral carcinoma, while utilizing the same technical principles as the standard open surgical approach. The minimally invasive approach may lead to fewer postoperative complications, particularly related to wound healing, while maintaining good oncologic outcomes. Thomas P. Frye and Alex Gorbonos have nothing to disclose. Runtime of video: 6 mins 31 secs