Robot-assisted laparoscopic antegrade versus open inguinal lymphadenectomy: a retrospective controlled study

Abstract

BackgroundTo investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy.MethodsA retrospective study was performed on clinical data from 19 patients with penile cancer admitted from March 2013 to October 2017. Among them, nine patients underwent robot-assisted laparoscopic antegrade inguinal lymphadenectomy (robot-assisted group) and 10 patients underwent open inguinal lymphadenectomy (open group). In the robot-assisted group, preoperative preparation, patient position, robot placement, design of operating channel and establishment of operating space are described. Key surgical procedures and techniques are also summarized. In addition, the number of lymph nodes removed, postoperative complications and follow-up in both groups were statistically analyzed.ResultsFor the 9 patients in the robot-assisted group, surgery was successfully accomplished at 17 sides without intraoperative conversion to open surgery. The surgery time for each side was 45~90 min using laparoscope with an average of 68.5 ± 13.69 min/side. The intraoperative blood loss was estimated to be < 10 ml/side, and the number of removed lymph nodes was not significantly different from that of the open group (12 ± 4.2/side vs.11 ± 5.8/side, P = 0.84). There were no postoperative complications such as skin necrosis, delayed wound healing and cellulitis in the robot-assisted group. Skin-related complications occurred in 9 (45%) of the 20 sides in the open group. During a median follow-up of 25 months in robot-assisted group and 52.5 mouths in open group, was not significantly different there were no statistical differences in recurrence-free survival between the groups (75% vs 60%, p = 0.536).ConclusionRobot-assisted laparoscopic antegrade inguinal lymphadenectomy achieved the desired surgical outcomes with fewer intraoperative and postoperative complications. The robotic arms of the surgical system were placed between the lower limbs of each patient. There was no need to re-position the robotic arms during bilateral inguinal lymphadenectomy. This simplified the procedure and reduced the use of trocars. If necessary, pelvic lymphadenectomy could be performed simultaneously using the original trocar position.

Minimal invasive approaches in lymph node management of carcinoma of penis

“…Wound infection and skin necrosis are rarely encountered in VEIL when compared to open surgery. [ 16 23 28 ] The incidence of lymphocele and lymphedema were similar in both the groups. [ 16 18 23 ] Complications reported with VEIL, were few in number and of less severity requiring conservative management.…”

“…[ 16 23 28 ] The incidence of lymphocele and lymphedema were similar in both the groups. [ 16 18 23 ] Complications reported with VEIL, were few in number and of less severity requiring conservative management. [ 18 ] More severe complications particularly wound infection and cellulitis were reported in groin node-positive patients.…”

“…Yu et al . [ 23 ] advocate a hypogastric approach for R-VEIL with utilizing skin incisions for the ports for pelvic lymphadenectomy if needed. Injecting indocyanine green at the base of the tumor during partial penectomy and dissecting the nodes using near infrared fluorescence (firefly) during R-VEIL has also been described.…”

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

“…For patients who had positive pathological results, pelvic lymphadenectomy was then performed simultaneously using the original skin incision with the patient's position and position of the robotic arm not shifting as previously described [23].…”

“…In this study, we compared the clinical outcomes of RAIL and LIL performed via the antegrade approach, and there was no need in this approach to re-position the robotic platform, unlike the retrograde [14-22, 24-25] and lateral approaches [11,12], and pelvic lymphadenectomy could be performed simultaneously using the original trocar position, if necessary [23].…”