Initial experience with videoscopic inguinal lymphadenectomy

Inguinofemoral lymphadenectomy is associated with frequent and marked incision-related morbidity. Our initial feasibility study of videoscopic inguinal lymphadenectomy (VIL) for melanoma showed appropriate nodal yield and anatomic dissection. Although a limited suprafascial dissection has been reported in the urologic literature, we report our growing experience with VIL applying a comprehensive approach to dissection.

Patients with inguinal metastases from varied malignancies were offered VIL. With institutional review board approval, procedures were performed via three ports: one at the apex of the femoral triangle, a second medial to the adductor, and a third lateral to sartorius. Femoral vessels were skeletonized, and all lymphatic tissue within the femoral triangle to 5 cm up onto the external oblique aponeurosis was resected. Specimens were removed through the apical port via a specimen bag. Clinicopathologic and perioperative outcome data were recorded.

Forty-five VILs were performed in 32 patients: 19 had unilateral VILs, and 13 had bilateral VILs for neuroendocrine, extramammary Paget disease, or varied genitourinary malignancies. Nine procedures (20%) were performed in women. Median age was 61 (range 16-87) years. Median body mass index was 30 (range 19-53). Median operative time was 165 (range 75-245) minutes, median length of stay was 1 (range 1-14) day, and median drain duration was 15 days. Median number of collected nodes was 11 (range 4-24), and the largest node removed was 5.6 cm in size. Wound complications were observed in 8 cases (18%). Six patients (13%) developed cellulitis without any wound dehiscences, 1 patient developed a seroma, and 1 patient with diabetes had mild skin flap necrosis, which resolved with minimal local care.

VIL is an alternative approach to traditional open inguinal lymphadenectomy. In our growing experience, node retrieval is appropriate and wound complications are substantially fewer than reported via an open approach. Further comparative analysis of VIL and traditional inguinofemoral lymphadenectomy is being pursued in a randomized, prospective trial.