V09-08: Laparoscopic (Robot-assisted) VEIL - A Single centre experience - Saphenous sparing vs non saphenous sparing
Open inguinal lymphadenectomy is a well-established therapeutic and diagnostic option for patients with invasive penile SCC who are at risk of regional and distant metastases. Despite the use of thick skin flaps based on the blood supply superficial to Scarpa’s fascia, perioperative complications of cellulitis, flap necrosis, and leg edema can affect as many as two thirds of patients We report the use of endoscopic robotic-assisted inguinal lymph node dissections in high risk patients or palpable lymph nodes
We reviewed our patient series from 2012 till 2018 which included carcinoma penis and carcinoma of distal urethra and analysed the data set. Our technique of R-VEIL is shown in the video. A 2-cm mid-thigh incision was made to develop a plane just deep to Scarpas' (fatty) fascia. Once a sufficient working space was created to place 3 robotic ports and 1 assistant port, subcutaneous gas was instilled, and the robotic device was docked and used to perform the dissection. The surgical approach replicated the principles of open techniques such that the contents of the femoral canal were dissected to include both superficial and deep lymph nodes in the dissection template
A total of 35 groins in 25 patients patients underwent R-VEIL in this period of 6 years. Mean age was 59.2 years. Five patients underwent simultaneous bilateral veil while the rest underwent unilateral. The use of saphenous sparing approach was done in 14 patients. R-PLND was performed in nineteen of the thirty five. The total console time reduced from 230 minutes to less hundred minutes with experience. The mean EBL was 67ml. the average lymphnode yield was around 15 nodes. Lymphocele was the commonest complication most of which were managed conservatively.
Early results suggest that this approach is feasible, safe, and affords an appropriate oncological dissection in selected patients. The reduction of local complications and morbidity is the greatest advantage.