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Combined endoscopic and open inguinal dissection for malignant melanoma
Claus Schneider1, Jens P Brodersen, Hubert Scheuerlein
1Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Hanover Medical School, Roesebeckstrasse 15, 30449 Hanover, Germany. claus.schneider.siloah@klinikum-hannover.de
Langenbeck'S Archives of Surgery
|April 12, 2003
Summary
Endoscopic pelvic dissection combined with superficial inguinal dissection offers improved local tumor control for malignant melanoma patients. This minimally invasive approach reduces operative trauma without increasing complications or compromising oncological outcomes.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Inguinal dissection is indicated for malignant melanoma with positive sentinel nodes or lymph node metastases.
- The deep (pelvic) component of inguinal dissection remains a topic of debate.
- An endoscopic extraperitoneal approach for pelvic lymph node dissection has been implemented.
Purpose of the Study:
- To evaluate the safety and efficacy of an endoscopic extraperitoneal approach for pelvic lymph node dissection in malignant melanoma patients.
- To assess the impact of this technique on operative trauma and oncological outcomes.
Main Methods:
- A combination of endoscopic extraperitoneal pelvic lymph node dissection and conventional superficial inguinal dissection was performed.
- The extraperitoneal space was accessed using a dissection balloon for para-iliac and obturator lymph node dissection.
Main Results:
- Thirty-one dissections were performed on 30 malignant melanoma patients between April 1999 and June 2002.
- No intraoperative or postoperative complications were observed with the endoscopic portion of the procedure.
Conclusions:
- Endoscopic pelvic dissection facilitates complete lymph node removal, enhancing local tumor control.
- This technique reduces operative trauma without compromising oncological radicalness or increasing morbidity.
- The approach is recommended for surgeons experienced in endoscopic extraperitoneal procedures.