Minimizing the Morbidity of Lymphadenectomy

Standard lymphadenectomy consists of the removal of all lymph nodes in the inguinal region. Recent lymphoscintigraphical and anatomical data indicate that limiting the dissection field to the central and craniomedial part may provide oncological control.19,22 Further mapping studies are in order to test the safety of this modified lymphadenectomy. Moreover, to be of real clinical value, there should be evidence of a reduction in the complication rate. An alternative option which could minimize the morbidity associated with the procedure involves using the technique of video endoscopic inguinal lymphadenectomy (VEIL). Some small series have now shown promising results with lower complication rates compared with an open procedure. Tobias-Machado et al. have reported their initial results of ten patients without palpable lymph nodes who underwent VEIL on one side and the standard open approach on the contralateral side. Although operative times were longer with the endoscopic approach compared with the open method, the mean number of retrieved and tumor-positive lymph nodes were similar. Moreover, there was a trend toward decreased postoperative morbidity.73 In another study reporting on their expanding experience, the VEIL approach led also to a significant decreased hospital stay (mean of 1 day vs. 6.4 days in patients who had undergone standard lymphadenectomy on one limb).74 The robot-assisted procedures have also recently been published in a case report.75 Until long-term oncological results are available, the laparoscopic lymphadenectomy technique is still considered investigational.

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