A video demonstration and case series of a modified split thickness skin graft technique using Artiss Sealant (R) performed with penile cancer procedures

Abstract

NTRODUCTION AND OBJECTIVE: Glans resurfacing andglansectomy are established procedures for the treatment of penileintraepithelial neoplasia (PeIN) and penile squamous cell carcinoma(PSCC), both commonly requiring simultaneous split thickness skingraft (STSG). Artiss SealantÒ(Baxter, Wilmington, USA) is a slow-settingfibrin sealant approved for use in skin grafting procedures.Since 2019 we have performed a modified STSG technique usingArtiss SealantÒ, with the aim of maintaining long-term STSG viabilityand short length of stay (LOS). We present a video demonstrating oursurgical technique in a representative case of glans resurfacingþSTSG using Artiss SealantÒ, with an associated case series.METHODS: We retrospectively reviewed STSG proceduresusing Artiss SealantÒperformed simultaneously with a penile cancerprocedure at a UK tertiary referral centre between February 2019 andOctober 2021. Outcomes measured were LOS, STSG loss, read-mission within 28 days, requirement for repeat STSG procedure anddisease recurrence during follow-up. One representative case of glansresurfacingþSTSG was prospectively consented for clinicalphotography,filmed professionally and video edited for educationalpurposes. Audit approval was obtained from the host clinicalgovernance committee.RESULTS: 12 cases met inclusion criteria, including 6 STSGsperformed simultaneously with glansectomy, 5 with glans resurfacingand 1 with wide local excision (WLE) of penile lesion. Median age was57 years (range 36-70), body mass index 30 (range 23-37) andCharlson Comorbidity Index 1 (range 0-3). Glansectomy casesdemonstrated stage pT2 grade 2-3 (4) and pT1 grade 2 (2) PSCC;Glans resurfacing cases demonstrated pT1 grade 1-3 (2) PSCC andPeIN (3). The WLE case demonstrated PeIN. Median LOS was 30hours (range 9-84 hours). All 12 STSGs remained viable at thefirstpost-operative clinic review (median 8 days, range 6-17) and allremained healthy for the duration of follow-up (median 5 months,range 1-24). 1 patient was readmitted within 28 days for reasonsunrelated to STSG procedure. No patient required repeat STSGprocedure, and no recurrences were detected during follow-up.CONCLUSIONS: Our video demonstrates our technique forperforming STSG using Artiss SealantÒsimultaneously with a penilecancer procedure, with a case series demonstrating short LOS andpreserved long-term STSG viability.Source of Funding:NoneV11-08SINGLE-PORT ROBOTIC ANTEGRADE BILATERAL INGUINALLYMPH NODE DISSECTIONNathan Cheng*, Hackensack, NJ; Christopher Wright, Nutley, NJ;Nizar Bou Diab, Hackensack, NJ; Mubashir Billah, Mutahar Ahmed,Nutley, NJINTRODUCTION AND OBJECTIVE: High risk penile cancerfollowing penectomy is often treated with inguinal lymph node dissec-tion. Classically, inguinal lymph node dissections were performed byopening both inguinal regions, with risk of wound complicationsincluding skin break down,flap necrosis, and lymphatic complicationssuch as lymphedema or lymphoceles. With the popularization of thesingle-port robotic system, novel surgeries have taken advantage of itsability to work in tight spaces. Here, bilateral inguinal lymph nodedissection is performed through a single suprapubic incision using thesingle-port robot. The goals are to minimize wound complicationsassociated with open inguinal lymph node dissections whilemaintaining safety and oncologic outcomes.