Single-Site Video Endoscopic Inguinal Lymphadenectomy: Initial Report

Abstract

Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization.

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

“…Tobias‐Machado et al. showed that LESS inguinal lymphadenectomy could provide better aesthetic results than conventional endoscopic inguinal lymphadenectomy. This conclusion was confirmed by our preliminary results; nine patients (75%) preferred the postoperative cosmetic results found in the limb that underwent LESS inguinal lymphadenectomy than those of their contralateral limbs that underwent conventional endoscopic inguinal lymphadenectomy.…”

“…For the LESS inguinal lymphadenectomy procedure (total 12 limbs), a skin incision of 2.5 cm was made 2 cm distal to the lower vertex of the femoral triangle . After blunt finger dissection, a domestic multi‐access platform (Fig.…”

“…A relatively novel technique, laparoendoscopic single‐site (LESS) surgery, has been performed successfully in a variety of urological procedures including live donor nephrectomy, ureterolithotomy, partial nephrectomy and adrenalectomy . In 2011, Tobias‐Machado et al . first reported LESS inguinal lymphadenectomy, but, to the best of our knowledge, there is little information on experience with LESS inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy.…”

Video endoscopic-assisted inguino-femoral lymphadenectomy (VEIL) in squamous cell invasive vulvar carcinoma: our initial experience

“…The number of lymph nodes harvested is comparable with open inguinal lymphadenectomy [18,23,26,29,30] and with the advantage of less subcutaneous flap injuries and attendant complications, shorter hospitalization, and early patient ambulation and recovery [17,[23][24][25][26][29][30][31]. Our operating time was significantly longer compared to classical surgery, but we believe that standardized surgical procedures, improvements of endoscopic instrumentation, and a dedicated trained surgical team could considerably improve this aspect.…”

“…In 2006, Tobias-Machado et al [17] published an initial case report of video endoscopic inguinal lymphadenectomy compared with a controlateral open radical procedure. VEIL continues to evolve: single site and robotic variants were recently presented [18][19][20].…”