V10-07: Da Vinci Robot Assisted Video Endoscopic Inguinal Lymphadenectomy : Video Demonstration of The Technique
VideoIntroductions and Objectives
Inguinal lymphadenectomy is a well-established therapeutic option for patients with invasive penile squamous cell carcinoma who are at risk of regional metastases but with high incidence of wound related morbidity. The objective is to report the use of endoscopic robotic-assisted Video Endoscopic Inguinal Lymphadenectomy (R-VEIL) in managing the groin of these patients highlighting the steps in the video segments.
We have performed 9 R-VEIL for 7 cancer penis patients in last 14 months. Two patients underwent bilateral and five had unilateral R-VEIL. All had high grade primary tumor with clinically negative groin and in five groins, frozen section was positive for lymph node metastasis who had robotic pelvic dissection as well in the same sitting. Technique of R-VEIL involves a 2-cm mid-thigh incision and developing a plane just deep to Camper's (fatty) fascia by using finger dissection. After creating sufficient working space 3 robotic ports and 1 assistant port are placed, and the robotic device (Da Vinci Si HD) was docked. Inguinal triangle was dissected to include both superficial and deep lymph nodes in the dissection template.
Mean age of the patients was 58 years (Range 50- 66). Mean console time was 130 mts (Range 110-190) for each groin, blood loss 70 ml (Range 30-100ml). There were no intraoperative complications. None of the patient had wound related complications like necrosis, infection. Average time for lymphorrheoa to stop was 14 days. Two patients had lymph drainage for 20 and 23 days. With mean follow up of 9 months none of the patient had local recurrence. One developed para-aortic lymph node metastasis and died of disease.
With our initial experience with R-VEIL in selected patients, a minimally invasive approach circumventing the need for thick skin flaps, the improved flexibility afforded by robotic instruments, and the improved magnification could decrease the morbidity associated with inguinal lymphadenectomy while maintaining oncologic principles. However long term follow up with more number are needed to draw conclusions on oncological safety.