Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes

Abstract

Objectives: Describe and illustrate a new minimally invasive approach for the radical resection of inguinal lymph nodes. Surgical Technique: From the experience acquired in 7 operated cases, the video endoscopic inguinal lymphadenectomy (VEIL) technique was standardized in the following surgical steps: 1) Positioning of the inferior member extended in abduction, 2) Introduction of 3 work ports distal to the femoral triangle, 3) Expansion of the working space with gas, 4) Retrograde separation of the skin flap with a harmonic scalpel, 5) Identification and dissection of the long saphenous vein until the oval fossa, 6) Identification of the femoral artery, 7) Distal ligature of the lymph node block at the femoral triangle vertex, 8) Liberation of the lymph node tissue up to the great vessels above the femoral floor, 9) Distal ligature of the long saphenous vein, 10) Control of the saphenofemoral junction, 11) Final liberation of the surgical specimen and endoscopic view showing that all the tissue of the region was resected, 12) Removal of the surgical specimen through the initial orifice, 13) Vacuum drainage and synthesis of the incisions. Comments: The VEIL technique is feasible and allows the radical removal of inguinal lymph nodes in the same limits of conventional surgery dissection. The main anatomic repairs of open surgery can be identified by the endoscopic view, confirming the complete removal of the lymphatic tissue within the pre-established limits. Preliminary results suggest that this technique can potentially reduce surgical morbidity. Oncologic follow-up is yet premature to demonstrate equivalence on the oncologic point of view.

Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations

“…The feasibility of endoscopic subcutaneous inguinal lymphadenectomy nowadays is well established and is an option in experienced laparoscopic hands (7). Since the introduction of VEIL by Tobias-Machado in 2006, there has been a surge of interest in this technique (8). Although VEIL surgery is technically demanding primarily because of the small working space, more than 20 centers, including the use of robotic platform, have reported their initial experience with similar technical success and improved morbidity rates (1).…”

Video Endoscopic Inguinal Lymphadenectomy: Refi ning surgical technique after ten years experience

“…We believe that proposed modifi cations can be applied to robotic surgery as well. We speculate that, in the near future, robotic platform can improve lymphatic identifi cation by using green fl uorescence, as in other procedures [4].…”

“…1 -Before performing the procedure, an ultrasound of the inguinal region was done and we ink marked the detected lymph nodes and saphenous vein [4] (Figure 1). …”

“…Inguinal nodal involvement is found in 20% to 40% of cases at diagnosis and nodal metastasis is an important predictive factor for survival [2,3]. Metastatic penile carcinoma has an extremely poor prognosis, since reported results of systemic therapy have been disappointing, even when improvement is achieved [4][5][6][7][8][9][10][11][12].…”

Update in the management of penile cancer

“…Many of the issues that arise are wound related complications; the use of a Gibson incision has been advocated by some authors to reduce them (10). Minimally invasive means of performing inguinal lymphadenectomy, via straight laparoscopy or with robotic assistance, have practically eliminated cutaneous complications (70)(71)(72)(73)(74). Prophylactic antibiotics, the appropriate use of drains, early ambulation, and modifications in surgical technique, among others, encompass some of the changes that have been applied with success in minimizing morbidity (68,69).…”