Video endoscopic inguinal lymphadenectomy for radical management of inguinal nodes in patients with penile squamous cell carcinoma

Abstract

Background:Inguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications such as lymphocele, skin loss, and infection.Aims:To report our institutional experience with video endoscopic inguinal lymphadenectomy (VEIL) for radical management of inguinal nodes in patients with penile squamous cell carcinoma.Materials and Methods:It is a prospective analysis of data of patients that underwent VEIL, by a single surgeon, from 2008 to 2015. 14 patients of penile carcinoma were suitable for VEIL technique were included in this study and followed. Data analyzed included mean operative time, mean lymph node yield, intraoperative complications, cutaneous complication, lymph-related complications, and surgical emphysema.Results:The mean age of patients was 57.8 years (range: 45–70 years). Mean operative time for VEIL was 194.86 min (178–210 min). Mean lymph node yield was 7.68 (range: 5–11 nodes). No intraoperative complication was experienced during series. We noted no cutaneous complications, localized lymphocele were seen in total 6 units out of 22 units (27.2%). Surgical emphysema is seen in 3 limbs (13.63%). There was significantly decreased overall morbidity in our study. Follow-up of 10 out of 14 patients with median of 48 months shows no recurrence.Conclusions:In our early experience, VEIL is a safe and feasible technique in patients with penile carcinoma who require radical inguinal lymphadenectomy. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and reduces surgical morbidity substantially.

Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region

“…There was a significant statistical and unfavorable difference in relation to literature (14). The same was observed with other minor complications such as skin necrosis and bulging of surgical wound (9, 12, 14). We believe that all are related to the initial experience; therefore, proficiency is still not reached.…”

“…In this series of 20 VEIL, trans-surgical procedure was satisfactory in general, as the data presented in Table-2. The surgical time was excellent, statistically significant when compared to other series in literature (8, 9, 12), probably due to rapid proficiency gathered by the surgeons, that previously attended practical and theoretic courses, under the guidance of an experienced tutor. It seems that these specific VEIL courses are able to allow the reproducibility of the surgery with adequate safety.…”

Low pressure video endoscopic inguinal lymphadenectomy in the treatment of penile cancer: a historical control study

“…Analyzing the reasons may be related to the use of conventional carbon dioxide gas pressure (12-15 mmHg) during the surgery. In previous studies of VEIL, the intraoperative CO 2 pressure is usually maintained at 12-15 mmHg [13,14] , which is usually used in laparoscopy. Since October 2015, we have improved the technology of VEIL, using low pressure (5-7 mmHg) during surgery, and the operation results are good.…”

Prevenir Complicações: Linfadenectomia Inguinal Modificada Vídeo-Assistida no Estadiamento do Tumor do Pénis

“…7,12,18,19 Mesmo em centros com elevado número de linfadenectomias inguinais abertas (LIA), as complicações minor (deiscência superficial da ferida, seroma, edema ligeiro do membro inferior) ocorrem em mais de dois terços dos casos, enquanto as complicações major (necrose do retalho cutâneo, trombose venosa profunda, linfocelo que necessita de drenagem) ocorrem em cerca de um terço dos casos. 12,16,18,20 A técnica aberta foi sofrendo modificações de forma a reduzir a taxa de complicações, com destaque para o uso de retalhos cutâneos mais espessos e com respeito pela vascularização superficial da faixa de Scarpa, disseção medial até ao nervo femoral, incisões cutâneas mais pequenas, preservação da veia safena ou transposição do músculo Sartorius. 16,21 Mesmo com estas modificações, a LIA associa-se a complicações em mais de um terço dos casos.…”

“…Vários estudos posteriores descreveram a técnica de LIMVA, sendo estes semelhantes nos passos fundamentais. 7,[15][16][17] A técnica descrita refere-se à LIMVA direita. 1) Posicionamento do doente: posicionamento semelhante à linfadenectomia inguinal aberta, com o doente em decúbito dorsal e com abdução e rotação externa da coxa, estando o joelho flectido em aproximadamente 100º.…”