Combined endoscopic and open inguinal dissection for malignant melanoma

Abstract

Background: Positive sentinel node biopsy or clinically/ radiologically demonstrable lymph node metastases in patients with malignant melanoma establishes the indication for inguinal dissection. Currently the deep (pelvic) part of the dissection is the subject of lively discussion. For the past 3 years we have been carrying out all pelvic lymph node dissections using an endoscopic extraperitoneal approach in combination with conventional superficial inguinal dissection. Methods: In analogy to endoscopic extraperitoneal hernia repair we open the extraperitoneal space with the aid of a dissection balloon and then perform a complete dissection of the para-iliac and obturator lymph nodes. The superficial part of inguinal dissection is then carried out in the conventional manner. Results: Among a total of 31 con-secutive dissections performed on 30 malignant melanoma patients between April 1999 and June 2002 neither intraoperative nor postoperative complications of the endoscopic part of the dissection were observed. Conclusions: While enabling better local tumor control as a result of the complete dissection, this modification entailing the use of endoscopic pelvic dissection also appreciably reduces the extent of operative trauma without compromising oncological radicalness or increasing morbidity. We recommend this approach to all surgeons with experience with endoscopic extraperitoneal procedures for use in patients requiring inguinal dissection.Keywords Melanoma metastatic to inguinal nodes · Dissection of the groin · Endoscopic extraperitoneal dissection

Videoscopic ilioinguinal lymphadenectomy for groin lymph node metastases from melanoma

“…The number of excised LNs (median 21, i.q.r. [15][16][17][18][19][20][21][22][23][24][25] as an indicator of surgical quality is shown in Table 4.…”

“…Videoscopic inguinal and iliac dissections have already been described for patients with melanoma, whereas this study evaluated both approaches in a single operation. The results suggest that videoscopic ilioinguinal LN dissection is feasible in most patients with either a positive SLN biopsy or clinically positive nodes.…”

Iliac Lymph Node Resection with Modified J Shaped Incision for Improved Exposure in Iliac Metastases: Case Report

“…5 Besides that, video-assisted endoscopic inguinal LND is currently investigated as a minimally invasive and less morbid approach. 2 . However, laparoscopic dissection techniques are not easy to master and have a steep learning curve.…”

“…he ideal incision for ilioinguinal dissection permits maximum exposure of the operative field, provides viability of the skin flaps with protection of the major vessels and an acceptable cosmetic result. [1][2][3][4][5][6] Classical vertical and oblique incisions generally don't provide adequate exposure and have an increase risk of vessel and nerve injury. [1][2][3][4][5][6] Therefore, we have used the modified hockey stick incision in iliac melanoma metastasis patients to maximize surgical exposure and decrease morbidity and would commend on this technique.…”