Preservation of the saphenous vein during laparoendoscopic single‐site inguinal lymphadenectomy: comparison with the conventional laparoscopic technique

Abstract

ObjectiveTo prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single‐site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes. Patients and Methods A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein. All lymphatic tissue in the boundaries of the adductor longus muscle (medially), the sartorius muscle (laterally), 2 cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply) was removed in both surgical techniques. All 24 procedures were performed by one experienced surgeon. Results All 24 procedures (12 LESS and 12 conventional endoscopic inguinal lymphadenectomies) were completed successfully without conversion to open surgery. For LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy groups, the mean ± sd operating time was 94.6 ± 14.8 min and 90.8 ± 10.6 min, respectively (P = 0.145). No significant differences in the incidence of postoperative complications (skin‐related problems, hecatomb, lower extremity oedema, lymphatic complications and overall complications) were noted between the two groups (P > 0.05). No lower extremity oedema occurred in any limbs of the two groups. No significant differences were observed in either lymph node clearance rate or detection rate of histologically positive lymph nodes (P > 0.05). The patient satisfaction rate with scar appearance and cosmetic results was significantly better in the LESS inguinal lymphadenectomy group than in the conventional endoscopic inguinal lymphadenectomy group of (75 vs 25%; P = 0.039). Conclusions This preliminary study suggests that both LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESS inguinal lymphadenectomy/conventional endoscopic inguinal lymphadenectomy can effectively reduce the incidence of postoperative lower extremity oedema. LESS inguinal lymphadenectomy seems to provide better cosmetic results than conventional endoscopic inguinal lymphadenectomy.

A New Surgical Technique of Laparoscopic Retrograde Inguinal Lymph Node Dissection: Our Initial Experience

“…Nonetheless, these improved techniques may omit micro-metastasis, which may lead to considerable false negative rate and endanger the oncologic control. Additionally, the postoperative complication rate remains high, which ranges from 26.7-38.9% [17][18][19].…”

Technical considerations to minimize complications of inguinal lymph node dissection

“…Catalona [1988] first described the technique of saphenous vein preservation with the goal of minimizing complications in inguinal lymphadenectomy ( 6 , 13 , 14 ). In a study of six patients, Catalona proposed a modified inguinal lymphadenectomy which focused on minimizing lymphedema.…”

“…More recently, an endoscopic approach to mitigate the risk and morbidity has become popular for the management of penile cancer. Here we briefly describe the approach which has been previously published ( 8 , 9 , 14 , 16 , 18 ).…”

“…Yuan et al combined the endoscopic techniques presented by Tobias-Machado and others with a laparoscopic approach to saphenous vein preservation which they termed LESS lymphadenectomy ( 14 ). In the method they described, a 2.5-cm incision is made distal to the apex of the femoral triangle, and a single multi-access port is placed within the incision.…”

“…None of the patients in this study suffered from lower extremity edema postoperatively. The patients who underwent LESS reported better cosmesis with the single incision than the patients in the conventional endoscopic group (P=0.039) ( 14 ). Additional studies comparing LESS to other minimally invasive techniques are needed.…”