Saphenous-sparing Ascending Video Endoscopic Inguinal Lymph Node Dissection Using a Leg Approach: Surgical Technique and Perioperative and Pathological Outcomes

Christian D Fankhauser; Esther W C Lee; Allaudin Issa; Pedro Oliveira; Maurice Lau; Vijay Sangar; Arie Parnham

doi:10.1016/j.euros.2021.10.004

Saphenous-sparing Ascending Video Endoscopic Inguinal Lymph Node Dissection Using a Leg Approach: Surgical Technique and Perioperative and Pathological Outcomes

Eur Urol Open Sci. 2021 Nov 18:35:9-13. doi: 10.1016/j.euros.2021.10.004. eCollection 2022 Jan.

Authors

Christian D Fankhauser^{1

2

3}, Esther W C Lee¹, Allaudin Issa¹, Pedro Oliveira¹, Maurice Lau¹, Vijay Sangar¹, Arie Parnham¹

Affiliations

¹ The Christie NHS Foundation Trusts, Manchester, UK.
² Luzerner Kantonsspital, Lucerne, Switzerland.
³ University of Zurich, Zurich, Switzerland.

Abstract

Background: Open inguinal lymph node dissection (oILND) has high morbidity. Ascending saphenous-sparing video endoscopic ILND (VEILND-AS+) represents a minimally invasive alternative with potential benefits.

Objective: To describe our VEILND-AS+ technique and compare outcomes to oILND.

Design setting and participants: This was a retrospective cohort study of penile cancer patients.

Surgical procedure: VEILND-AS+ was performed according to the technique described in the supplementary video.

Measurements: We compared perioperative and pathological outcomes between the two procedures.

Results and limitations: In the study cohort of 206 men we performed 40 VEILND-AS+ and 251 oILND procedures. In comparison to oILND, VEILND-AS+ had a longer operation time (185 vs 120 min; p < 0.01) but a shorter hospital stay (2 vs 4 d; p < 0.01). A median of eight resected lymph nodes with a median of one affected node per groin was observed in both groups. Extranodal extension was found in 30% of cases after VEILND-AS+ and 35% after oILND. In both groups the median drainage time was 13 d. Wound infections were observed in 38% of cases after VEILND-AS+ and 27% after oILND (p = 0.19). Skin necrosis or wound breakdown occurred in 0% and 6% of cases after VEILND-AS+ and oILND (p < 0.01), while lymphoceles were drained in 18% and 7% of cases, respectively(p = 0.03). Following VEILND-AS+ and oILND, 20% and 14% of patients, respectively, were referred to a lymph oedema clinic (p < 0.01).

Conclusions: VEILND-AS+ is a safe procedure and offers shorter hospital stays and possibly a lower risk of skin necrosis and wound breakdown in comparison to oILND. Further improvements in the VEILND-AS+ technique are required to reduce complications associated with dead space and injury to lymphatic vessels.

Patient summary: For patients undergoing surgery on lymph nodes in the groin, a minimally invasive approach instead of open surgery led to discharge 2 days earlier and may have lower rates of severe wound complications.

Keywords: Inguinal lymph node dissection; Minimally invasive surgery; Penile cancer; Video endoscopic inguinal lymph node dissection.