Video Endoscopic Inguinal Lymphadenectomy (VEIL) -a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma

Abstract

BackgroundInguinal 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. Video Endoscopic Inguinal Lymphadenectomy (VEIL) is an endoscopic procedure, and it seems to be a new and attractive approach duplicating the standard open procedure with less morbidity. We present here a critical perioperative assessment with points of technique.MethodsTen patients with moderate to high grade penile carcinoma with clinically negative inguinal lymph nodes were subjected to elective VEIL. VEIL was done in standard surgical steps. Perioperative parameters were assessed that is - duration of the surgery, lymph-related complications, time until drain removal, lymph node yield, surgical emphysema and histopathological positivity of lymph nodes.ResultsOperative time for VEIL was 120 to180 minutes. Lymph node yield was 7 to 12 lymph nodes. No skin related complications were seen with VEIL. Lymph related complications, that is, lymphocele, were seen in only two patients. The suction drain was removed after four to eight days (mean 5.1). Overall morbidity was 20% with VEIL.ConclusionIn our early experience, VEIL was a safe and feasible technique in patients with penile carcinoma with non palpable inguinal lymph nodes. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and potentially reduces surgical morbidity.

Video endoscopic inguinal lymphadenectomy for lymph node metastasis from solid tumors

“…Zhou et al 34 11 36.4 n.r. 0 Mean 126 (range 90e180) Abbott et al 35 13 0 15e25 7.7 245 (IQR 205e366) vs 138 (IQR 102e179) p ¼ 0.0003 Pahwa et al 36 10 0 12 0 135 (range 120e180) n.r. ¼ not reported.…”

“…29,33,37 Only one study reported data on the occurrence of post-operative lymphedema, which was detected in the 11% of cases. Hospital stay and drainage duration were extremely heterogenous, ranging from 1 to 11 days 28,29,32,34e36 and 5e28 days, 31,32,35,36 respectively. Strikingly, in two studies hospital stay after VEIL was significantly lower compared to open IL.…”

“…28 The 30 camera was adopted in the majority of cases. The saphenous vein was preserved in three studies, 28,33,36 removed in three, 29,31,35 and preserved in 50 and 63% of the procedures in the remaining two trials, respectively. 30,34 The saphenous vein was sectioned with endostaplers or endoclips.…”

Robotic Bilateral Inguinal Lymphadenectomy in Penile Cancer, Development of a Technique Without Robot Repositioning: A Case Report

“…Recently, a group in India has reported similar experiences [12]; in ten patients, no skin-related complications were seen. Lymphocele was seen in 2/10 (20%) of patients, lymph node yield was 7-12 lymph nodes.…”

Current surgical management of penile cancer

“…The saphenous vein is also not always preserved. 63 Tobias-Machado et al 64,65 reported favorable oncological and cosmetic outcomes with VEIL in a group of patients with nonpalpable ILNs. A similar number of ILNs were excised compared to the open approach and no reported recurrences or cases of disease progression were noted at a mean follow-up of 18.7 months.…”