Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations

Abstract

Purpose: To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the management of patients with indication for inguinal lymphadenectomy. Surgical Technique: VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO 2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. Results: A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. Conclusion: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.

Low pressure video endoscopic inguinal lymphadenectomy in the treatment of penile cancer: a historical control study

“…No matter what kind of incision is used in open inguinal lymphadenectomy, there is a higher chance of complications such as ap necrosis and incision infection [8,9] . Since 2003, some studies have reported the use of VEIL, and this technique is considered safe and effective [10][11][12] . We carried out video endoscopic inguinal lymphadenectomy since 2013, and analyzed the results of the surgery.…”

Prevenir Complicações: Linfadenectomia Inguinal Modificada Vídeo-Assistida no Estadiamento do Tumor do Pénis

“…23 Outra forma de diminuir a morbilidade é a realização da LIMVA bilateral em simultâneo por duas equipas cirúrgicas distintas, variante técnica descrita por Pompeo et al em 2013. 10 Apesar do potencial mostrado pela LIMVA, outras técnicas minimamente invasivas têm surgido, nomeadamente a LIMVA robótica 24 e a abordagem por via abdominal/hipogástrica, 25 com resultados comparáveis à LIMVA.…”

“…[6][7][8][9] A linfadenectomia inguinal por via aberta, procedimento clássico, associa-se a uma elevada taxa de complicações (>50%), nomeadamente infeção da ferida operatória, necrose da pele, edema dos membros inferiores e linfocelo. 7,[9][10][11][12] Em casos de doentes cN0, a linfadenectomia modificada é uma opção mais segura, consistindo na remoção de gânglios superficiais e da zona central, com preservação da veia safena magna. 9,13 Com o objetivo de diminuir cada vez mais a morbilidade do procedimento, foi desenvolvida a linfadenectomia inguinal modificada vídeo-assistida (LIMVA), respeitando os mesmos princípios oncológicos que a técnica clássica aberta.…”

Endoscopic inguinal lymphadenectomy in penile cancer: case report and literature review

“…In 2013 the feasibility was reported of simultaneously carrying out the EIL with a reduction in operation time and the benefits already described as for the minimally invasive technique [ 27 , 28 ].…”