Ces Urol 2019, 23(3):183-185

VEILND (VideoEndoscopic Inguinal Lymph Node Dissection) in penile cancer ≥ pT1G2 and cN0

Milan Hora¹, Ivan Trávníček¹, Petr Stránský¹, Štěpánka Nykodýmová¹, Matúš Mlynarčík¹, Jiří Ferda², Denisa Kacerovská³, Ondřej Hes³

¹ Urologická klinika, FN Plzeň

² Klinika zobrazovacích metod, FN Plzeň

³ Šiklův ústav patologie, FN Plzeň

Hora M, Trávníček I, Stránský P, Nykodýmová Š, Mlynarčík M, Ferda J, Kacerovská D, Hes O. VEILND (VideoEndoscopic Inguinal Lymph Node Dissection) in penile cancer ≥pT1G2 and cN0.

Introduction: Invasive diagnosis is indicated in penile carcinoma ≥pT1G2 cN0 (palpable or controversially palpable non-tumorous inguinal nodes). Either a scintigraphically labelled sentinel node (DSLNB) biopsy with false negative risk over 10% or more accurate but more invasive modified inguinal lymphadenectomy (ILND), done usually as open surgery. In particular, modified ILND is indicated in associated risk factors (more aggressive histology, positive inguinal nodes in FDG PET MRI / CT, in younger men). To reduce complications, we introduced a mini-invasive "laparoscopic" ILND in 2017. We present our experience with methodology VEILND. File, methodology: From 3/2017 to 6/2019, 30 newly detected penile cancers were treated in our centre. In 10 we performed VEILND (19 groins, once unilaterally). Surgery performed in the supine position with lower limbs apart. With felt-tip marked on skin boundaries of a femoral triangle (anterior superior iliac spine, pubic tubercule - associated with inguinal ligament, sartorius and adductor longus muscle) and a suspected palpated sentinel node. From a short incision on the caudal top of the femoral triangle, a finger creates an operating space under Camper's fascia. Introduction of 2 ports - 5 and 11 mm (preferentially trocar with fixation balloons), incision videoport, optic optics. CO2 pressure at 12 mm Hg. Great saphenous vein is laterally or on the "roof" of the surgical area, sometimes dorsally, is preserved. To release lipolymphatic tissue from the base - femoral vessels, great saphenous vein, oval fossa, Camper's fascia and inguinal ligament - we use Ligasure® Maryland (or Blunt tip 5 mm). Extraction of lipolymphatic tissue in Endocatch® bag Gold or directly by incision without bag. Suction drain, ports' closure. Single shot antibiotic proxylaxis (co-amoxicillin), lower limb bandages, miniheparinization.

Results: In 8 men this was performed bilateral ly (one with pelvic lymphadenectomy), 1 unilaterally (there was not marked SLN on one side in the primary DSLNB). The mean age of men was 63.3 ± 10.4 (46-78) years. BMI 30.0 ± 4.7 (24.5-40.2). The operating time was in two-sided (7 cases) 134.4 ± 37.5 (91-192) min. In single-sided 66 min, both sides with pelvic LND 159 min. Average number of nodes obtained per groin 7.3 ± 3.1 (3-14) nodes. Metastaes were demonstrated in 7 groins (37%). The hospitalization period was 21.1 ± 12.1 (7-44) days. Complications occurred in 8 groins (42.1%). Once 3b by Dindo-Clavien (revision for bleeding followed by necrosis of the skin), 7× prolonged lymphorrea or lymphocoele with drainage necessity (3× infected).

Conclusion: The mini‑invasive approach to inguinal LND (VEILND) is technically feasible and our preferred method of approach now. The risk of complications resulting from insufficient closure of the lymphatic vessels also remains with this methodology.

Received: July 15, 2019; Accepted: August 16, 2019; Prepublished online: August 16, 2019; Published: September 26, 2019