V4-04: Novel Use of Fluorescence Lymphangiography During Robotic Groin Dissection for Penile Cancer
Indocyanine green (ICG) lymphangiography has been used to detect lymphatic channels under fluorescent light and to aid in the excision of affected lymph nodes. We describe our novel technique of robotic inguinal lymphadenectomy with near infrared fluorescence imaging using ICG to facilitate lymph node identification during robotic groin dissection for penile cancer.
Using a high definition recording system and iMovie software with narrative and annotative editing, we created a video of our novel technique for robotic inguinal lymphadenectomy with near infrared fluorescence imaging using the Surgical Intuitive Da Vinci Xi robot. Robotic ports are placed in a V configuration at the tip of the femoral triangle after development of the working space by blunt finger dissection. Intradermal ICG is injected at the penile stump or base (0.5 ml of 2 mg/kg concentration in normal saline) and the lymphatic channels and nodes are visualized with near infrared fluorescence imaging in the robotic console approximately 15 minutes after injection. The surgical template established via the open approach is then replicated.
A total of 8 groin dissections have been completed using this technique with a mean lymph node yield of 8 per groin (range 5-16 lymph nodes). With a follow up ranging from 3-16 months, there have been no post-operative infections, lymphatic leaks, wound breakdown, or necrosis. All pathologically proven nodes were identified intra-operatively with ICG.
Our novel technique of robotic inguinal lymphadenectomy with fluorescence lymphangiography using ICG facilitates identification of lymph channels and nodes. It is reproducible, safe, and helps ensure complete excision of both superficial and deep lymph nodes during groin dissection for penile cancer. This technique may dramatically decrease the morbidity compared to the open technique without compromising oncologic efficacy. Further prospective studies are required to assess the long term results of this procedure.