Laparoscopic and robotic video endoscopic inguinal lymphadenectomy by the lateral approach

Abstract

Introduction 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. Methods 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. Results 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. Conclusions Lateral VEIL is feasible and can be used as an alternative to conventional VEIL.

Saphenous-sparing Ascending Video Endoscopic Inguinal Lymph Node Dissection Using a Leg Approach: Surgical Technique and Perioperative and Pathological Outcomes

“…The first promising surgical technique is prophylactic lymphovenous anastomosis and shunts [13] , [14] . The second new approach worth exploring may include a lateral approach [15] , [16] , which could facilitate control of the distal medial lymphatics. A third development is hypogastric access [17] , involving access to the pelvic and inguinal nodes through a single hypogastric route.…”

Laparoscopic simultaneous anterograde inguinal and pelvic lymphadenectomy for penile cancer: two planses, three holes, and six steps

“…Compared with open surgery, laparoscopic anterograde inguinal lymphadenectomy can avoid long bilateral incisions and achieve the goal of minimally invasive surgery. Compared with retrograde inguinal lymphadenectomy via femoral puncture, anterograde VEIL avoided instruments fighting ( 8 ). In addition, the number of puncture holes was lower in our anterograde VEIL.…”

“…Currently, there is no unified surgical method for inguinal lymphadenectomy ( 8 ). The reported approaches include the hypogastric subcutaneous approach, leg subcutaneous approach (VEIL-L) ( 9 ), Lateral VEIL approach ( 8 ), and the Pelvic and Inguinal Single Access (PISA) approach ( 10 ). In conventional VEIL, a trocar is placed on the thigh and above the knee joint.…”

“…In conventional VEIL, a trocar is placed on the thigh and above the knee joint. However, the camera can hit the knee, the operator need move to reach the camera, and the instruments may be sword fighting ( 8 ).…”

Minimal invasive approaches in lymph node management of carcinoma of penis

“…[ 25 ] did a feasibility study and proved VEIL can be safely done in node-positive groin as well. Except for few studies,[ 26 27 28 ] most of the studies on VEIL are on mixed population of node-negative and positive patients with >70% the patients in former category. With the advent of robotic assistance, more node-positive patients were subjected to VEIL.…”