Modified Video Endoscopic Inguinal Lymphadenectomy: a Deep-First Approach

Das, Manoj Kumar; Pandey, Abhishek; Mandal, Swarnendu; Nayak, Prasant; Kumaraswamy, Santosh

doi:10.1016/j.urology.2022.06.005

Cited by 2 publications

(3 citation statements)

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“…Superficial fascia has recently been demonstrated in many other areas of the body (Fede et al, 2020; Macchi et al, 2007; Pirri, Fede, Petrelli, et al, 2021; Stecco, 2015; Stecco & Duparc, 2011); it has been described as a dense collagenous connective tissue layer of the anterior abdominal wall that divides the hypodermis into two distinct layers: the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). Numerous surgical approaches have been developed using superficial fascia as flaps during plastic reconstructive surgery (Koshima et al, 1996); it has also been used as a dissection guide during superficial lymphadenectomy (Das et al, 2022) and abdominoplasty/ liposuction procedures (Novais et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…connective tissue layer of the anterior abdominal wall that divides the hypodermis into two distinct layers: the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). Numerous surgical approaches have been developed using superficial fascia as flaps during plastic reconstructive surgery (Koshima et al, 1996); it has also been used as a dissection guide during superficial lymphadenectomy (Das et al, 2022) and abdominoplasty/ liposuction procedures (Novais et al, 2020). Novais et al (2020) recently reported that those abdominoplasty procedures during which Scarpa's fascia is preserved are characterized by beneficial effects in terms of scar quality and cutaneous sensibility with respect to other techniques.…”

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Blood supply to the superficial fascia of the abdomen: An anatomical study

et al. 2023

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The aim of this study was to examine data demonstrating that Scarpa's fascia, a superficial fascia of the anterior abdominal wall, is a vascularized tissue. Specimens of the fascia of seven volunteers undergoing abdominoplasty surgical procedures at the Plastic Surgery Unit of the University of Padova Medical Center were collected. Fractal analysis and quantitative assessment of the vascular network of the fascia was carried out, exploiting the presence of blood in the vessels. Each sample was divided and processed for histological/immunohistochemical analysis (into 5 micron-paraffin embedded sections and cryo-sectioned free-floating samples) as well as for electron microscopy study. A rich vascular pattern forming a fine, dense meshwork with an area percentage of 6.20% ± 2.10% von Willebrand factor stained vessels was noted in all the specimens of the fascia examined; the area percentage of the αSMA-stained vessels was 2.93% ± 1.80%. The diameters of the vessels fell between the 13 and 65 μm range; the network was composed of arteries, veins, capillaries and lymphatic segments. Topological results showed that the vascular network within Scarpa's fascia is well branched (segments: 6615 ± 3070 and 8.40 ± 3.40 per mm 2 ; crossing points: 3092 ± 1490 and 3.40 ± 1.90 per mm 2 ). Fractal analysis (fractal dimension = 1.063 ± 0.10; lacunarity = 0.60 ± 0.10) revealed that this particular vascular network has an optimal spatial distribution and homogeneity occupying the entire space of the superficial fascia. These findings could undoubtedly be useful to plastic surgeons as well as to pain management specialists.

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Section: Introductionmentioning

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Blood supply to the superficial fascia of the abdomen: An anatomical study

et al. 2023

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“…(2)(3)(4)9,10) o con asistencia robótica, (15)(16)(17) utilizando uno (un solo puerto) o más trocares, (18) colocándolos en la región hipogástrica o crural (a nivel del vértice del triángulo crural o lateral al músculo sartorio), (19)(20)(21) realizándola una después de otra o en simultáneo, (22,23) utilizando CO2 o equipos de tracción externa para crear el espacio de trabajo y finalmente iniciando la disección de la pieza operatoria superficialmente a nivel de la fascia de Scarpa o profundamente entre el músculo y el tejido celular. (24,25) En general, las diferentes publicaciones concluyen que las ventajas de la técnica se deben a incisiones pequeñas con menor lesión de piel, partes blandas, vasos y/o nervios, amplio espacio quirúrgico con menor trauma mecánico, mínimo uso de electrocauterio, amplificación visual con mejor reconocimiento de vasos, adecuado control hemostático y ligadura selectiva de linfáticos. (8) Como se desprende de diferentes reportes, con la adecuada elección de pacientes (cN0) y correcta realización del procedimiento se logra un buen control oncológico.…”

Section: Discussionunclassified

Linfadenectomía inguinal endoscópica en cáncer de pene: resultados oncológicos, funcionales y morbilidad a largo plazo

et al. 2022

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Objetivo: Presentar nuestra experiencia usando linfadenectomía inguinal endoscópica (LIE) en el manejo del cáncer de pene con factores de riesgo para metástasis y ganglios inguinales clínicamente negativos (cN0); evaluar los resultados obtenidos a largo plazo y con los descritos en la revisión de la literatura plantear “objetivos ideales” para esta técnica mínimamente invasiva. Metodología: Entre el 2012 y 2016, pacientes con diagnóstico de cáncer de pene que cumplieron los criterios de patología mayor a pT1G2 y ganglios inguinales cN0, fueron sometido a LIE. Registramos datos prequirúrgicos, perioperatorios, anatomo-patológicos y de seguimiento. Analizamos resultados y discutimos la evidencia descrita en la revisión de la literatura. Resultados: En 15 pacientes con una media de 59 años, se realizaron 23 LIE (08 bilaterales y 07 unilaterales). El tiempo operatorio promedio fue 126 minutos; todos los casos con sangrado menor a 50 cc. La media de ganglios disecados por región inguinal fue 10.4; en 3 pacientes se encontró 1 ganglio metastásico. No se presentaron complicaciones Clavien-Dindo III o IV. Durante el periodo de seguimiento promedio de 89 meses (rango 72-120), ningún paciente presentó recurrencia o progresión de enfermedad. Conclusiones: La evaluación a largo plazo en este grupo de pacientes ha mostrado ser una alternativa efectiva, segura y reproducible con resultados óptimos en control oncológico, pronta recuperación funcional y mínimas complicaciones intra y postoperatorias. Las diversas publicaciones coinciden en afirmar que tiene ventajas en comparación a la convencional, cumpliendo estos tres “objetivos ideales” que calificamos como trifecta, similar al concepto usado en otras cirugías uroncológicas.

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Modified Video Endoscopic Inguinal Lymphadenectomy: a Deep-First Approach

Cited by 2 publications

References 11 publications

Blood supply to the superficial fascia of the abdomen: An anatomical study

Blood supply to the superficial fascia of the abdomen: An anatomical study

Linfadenectomía inguinal endoscópica en cáncer de pene: resultados oncológicos, funcionales y morbilidad a largo plazo

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