Saphenous sparing ascending video-endoscopic inguinal lymph node dissection (VEILND-AS plus ) using a leg approach: Surgical technique, perioperative and pathological outcomes

Abstract

Introduction & Objectives: Open inguinal lymph node dissection (oILND) has a high morbidity. Video-endoscopic inguinal lymph node dissection (VEILND) represents a minimally invasive alternative with potential benefits. The aim of this study was to describe our saphenous sparing ascending video-endoscopic inguinal lymph node dissection (VEILND-AS+) using a leg approach and to compare the outcomes to our oILND experience. Materials & Methods: Retrospective cohort study of penile cancer patients undergoing either oILND or VEILND comparing perioperative and pathological outcomes. Results: In 206 men we performed 40 VEILND and 251 oILND. VEILND compared to oILND had a longer operation time (185 vs 120 minutes) but shorter hospital stay (2 vs 4 days). A median of 8 resected lymph nodes with a median of 1 affected node per groin was observed in both groups with extra nodal extension in 30% after VEILND and 35% after oILND. Both groups had a median of 13 days of drainage. Wound infections were observed in 38% after VEILND and 27% after oILND. Skin necrosis or wound break down occurred in 0% and 6% after VEILND and oILND, whilst lymphoceles were drained in 18% and 7% respectively. Following VEILND and oILND 20% and 14% were referred to lymph oedema clinic. Conclusions: In this video we describe our VEILND-AS+ technique and our data suggests that VEILND-AS+ is a safe procedure. Compared to oILND, VEILND-AS+ may offer a shorter hospital stay and possibly a lower risk of skin necrosis or wound break down. Further improvement of this and other VEILND techniques are required to decrease complications associated with dead space and injury to lymphatic vessels. This study is limited by its retrospective nature.