V6-09: Novel Robotic Approach to Inguinal and Pelvic Lymphadenectomy for Metastatic Melanoma in a 44 Year Old Male
To describe a new approach to pelvic lymphadenectomy designed to reduce complication rates.
This case describes the treatment of a 44 year old male requiring an inguinal lymph node dissection. This case was approached robotically in order to minimize complications. This video describes and demonstrates the robotic technique, as well as, the patient’s clinical course and follow-up under the care of one surgeon at a large, academic hospital.
Complete resection of the inguinal lymph nodes using the Da'Vinci Xi robot resulted in no complications with no signs of recurrence at follow-up.
Continued expectations to provide exceptional oncological care while minimizing morbidity have lead surgeons to novel treatment approaches for inguinal lymphadenectomy. Open inguinal lymph node dissections continue to have significant rates of complications. The vast majority of complications are due to tissue necrosis, wound dehiscence, seroma formation, and lymphedema. Previously published rates of seroma formation are as high as 32% for the open technique, while the instance of lymphedema may be as high as 40%. Wound infections also comprise a significant portion of morbidity at 24% and skin flap complications are reported at 52%. With this technique our cohort experienced one total Clavien grade II complication (20%) and had an average length of stay under two days which is similar to other minimally invasive techniques. _x000D_ Our oncological outcomes with this technique have been equivalent to the open approach to date. No patients have had recurrent disease. Our lymph node count per side ranges from 1-54; however, 60% of the groins contain 6 or greater lymph nodes. _x000D_ Robotic inguinal lymph node dissection represents a promising alternative to the traditional open technique with the possibility of lower overall morbidity. Additional studies should be conducted evaluating the oncologic efficacy of this approach. _x000D_