Yunlin Ye

Urology, Sun Yat-sen University Cancer Center

Objective:Inguinal lymphadenectomy is associated with incision-related morbidity frequently. Video endoscopic inguinal lymphadenectomy (VIL) is a recently described lymphadenectomy with the same template of the open technique, it was reported that it could decrease morbidity, and the oncological results were uncertain for short-term follow-up. To improve feasibility and effectiveness of VIL, we performed radical VIL with critical modification. Method: Patients with risks of inguinal metastases from penile cancer were offered VIL. Using three ports, which were 2cm below the inferior borderline: one at the middle with 10mm, one at the medial and lateral with 5mm, respectively. 4.5cm incision in the middle of the inferior borderline was performed, and a space about 8cm×3cm for videoscopic apparatus was exposed like OIL. Along the semitransparent membrane, tissues between the superficial layer of Camper's fascia and fascia lata were dissected. In this space, the saphenous vein was divided for preservation. Then the Trocar was set and the incision was sutured. The same template of the open technique was marked, and fine-needles were inserted into the videoscopic space to identify the borderlines. Specimens were removed through the inferior incision and the removal scope was checked. Clinico-pathologic and peri-operative outcome data were recorded. Result: Seventy VIL was performed in 38 patients with penile cancer. Median age was 42 (range 32-67) years. Median body mass index was 23 (range 18-33). Median operative time was 90 (range 65-135) minutes, and median number of collected nodes was 12 (range 8-17) in each lateral. Wound complications were observed in 7 laterals. Three patient developed lymphocyst without any wound dehiscences, 1 patient suffered infection and 3 patients with diabetes had mild skin flap necrosis, which resolved with minimal local care. Conclusion:Radical VIL is as feasible as open inguinal lymphadenectomy. In our growing experience, node harvest is more than modified VIL. Further comparative analysis of radical and modified VIL is being pursued in a larger, prospective trial.

Key Words: penile cancer, Inguinal lymphadenectomy, Video endoscopic