Robot-assisted video endoscopic inguinal lymphadenectomy for melanoma

Abstract

Inguinal lymphadenectomy is the indicated procedure in the regional lymph node management for patients with lower limb melanoma and positive nodes. This procedure is commonly associated with surgical site complications. Video endoscopic inguinal lymphadenectomy is a minimally invasive alternative with oncological principles and lower wound-related morbidity. Incorporation of robotic surgery with optimal vision and great maneuverability would offer great advantages. A 42-year-old male patient was diagnosed with acral lentiginous melanoma and palpable inguinal nodes T2 N1 M0. The patient was scheduled for robot-assisted left inguinal video endoscopic lymphadenectomy. The working space is created using blunt-finger dissection and then extended with the endoscope by sweeping with the lens. Two 8-mm robotic trocars and a 10-mm trocar for assistant are placed. The lymphadenectomy is carried out with Maryland and scissors. The operative time was 130 min, estimated blood loss 70 ml and hospital stay 2 days. The robot-assisted inguinal video endoscopic lymphadenectomy is a safe and feasible procedure for lower limb melanoma treatment. The incorporation of the robotic system to this approach where there is a limited working space would offer advantages to the technique.

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

“…Postoperative complication rates appear to bene t from minimally invasive approaches compared to OIL [3,20,21,23,[25][26][27]. When comparing LIL to open IL, there was a signi cant decrease in wound complications (0% vs 50%) as well as a trend toward lower overall complication rates (20% vs. 70%) [25], concordant with ndings reported by other investigators [16,17]. Similarly, Singh et al [20] reported lower complication rates with RAIL than with open IL (2% vs 17%), consistent with Yu et al [23], who reported that RAIL had fewer postoperative wound complications.…”

“…In terms of operative time, while some studies have reported no statistically signi cant difference between minimally invasive and open IL [26,27], most papers reported a longer operative time for minimally invasive surgeries. The operative time for RAIL when excluding reports combining inguinal lymphadenectomy with other procedures (e.g., vulvectomy, pelvic lymph node dissection) was quite variable, ranging from 45 to 279 min [5,17,18,24]. Similarly, various studies reported very heterogeneous results for the operative time of LIL, which ranged between 90 and 240 min [7][8][9][10][11][12].…”

The possible role of the da Vinci robot for patients with vulval carcinoma undergoing inguinal lymph node dissection

“…There is not enough evidence regarding the role of the da Vinci robot (Intuitive Surgical, Sunnyvale, USA) in groin node dissection. The approach has never been used for patients with vulval cancer; however, it has been used in patients with melanoma or penile cancer ( 6 , 8 , 10 , 11 , 12 ). We present the possible advantages of such an approach in patients with vulval cancer based on the experience from other specialties or the videoscopic technique ( 13 , 14 , 15 ).…”

Robot-assisted inguinal lymphadenectomy: preliminary experience and perioperative outcomes from an Italian referral center

“…1 Furthermore, ILND is the indicated procedure in regional lymph node management for other kinds cancer of the lower limb with positive nodes such as melanoma, Merkel cell carcinoma, and squamous cell carcinoma (SCC). 2…”

“…1 Furthermore, ILND is the indicated procedure in regional lymph node management for other kinds cancer of the lower limb with positive nodes such as melanoma, Merkel cell carcinoma, and squamous cell carcinoma (SCC). 2 Unfortunately, 10-46% of patients undergoing ILND are subject to complications, even in the most experienced hands. The most common complications reported are: wound dehiscence, cellulitis, skin necrosis, leg edema, and deep vein thrombosis.…”