Modified Laparoscopic Inguinal Lymphadenectomy Using an Abdominal Subcutaneous Approach

Summary

The efficacy of laparoscopic inguinal lymph node dissection is comparable to that of open surgery. It also significantly decreases the incidence of complications. In this study, a modified laparoscopic method was used for inguinal lymph node dissection through the abdominal subcutaneous approach for penile cancer treatment.

Abstract

Inguinal lymph node metastases significantly impact the prognosis of patients with penile cancer. Therefore, timely inguinal lymph node dissection is essential for the comprehensive treatment of penile cancer. Compared with the traditional open inguinal lymphadenectomy, laparoscopic inguinal lymphadenectomy offers similar tumor control with fewer complications. The current techniques for the laparoscopic surgical approach include L-lymphoid clearance sequence and preservation of the great saphenous vein. In this study, a transabdominal subcutaneous anterograde approach was employed to improve laparoscopic inguinal lymph node dissection and conserve the great saphenous vein, resulting in favorable outcomes. Furthermore, only 2 out of 21 patients experienced wound infections, and only 1 exhibited lymphatic leakage from the drainage orifice. These findings indicate that the use of an innovative subcutaneous transperitoneal retrograde approach is safe for abdominal endoscopic common iliac plexus dissection with fewer complications in patients with penile cancer compared with traditional open surgery. Notably, the postoperative survival rate of penile cancer patients is significantly influenced by the presence or absence of inguinal lymph node metastasis and the extent of metastasis. Timely inguinal lymph node dissection is essential since it significantly impacts the treatment of penile cancer. Besides, laparoscopic inguinal lymphadenectomy offers comparable tumor control to open surgery with significantly reduced complications. Notably, standardized approaches for laparoscopic surgery, cleaning procedures, and preservation of the saphenous vein are crucial for inguinal lymph node dissection. The laparoscopic inguinal lymphadenectomy technique can be improved by employing the abdominal subcutaneous anterograde approach. This article provides a comprehensive account of the procedures and technical improvements associated with the modified laparoscopic inguinal lymphadenectomy using the abdominal subcutaneous approach.

Introduction

Penile cancer is a relatively uncommon malignant tumor of the genitourinary system, with squamous cell carcinoma representing about 95% of cases. Penile cancer is mainly spread through the lymphatic system, with the initial site of dissemination being the inguinal lymph nodes¹. The superficial and deep inguinal lymph nodes are the main regional sites for the spread of penile cancer, followed by the pelvic lymph nodes, which include the external and internal iliac lymph nodes, with rare metastasis. Besides the grade and stage of the primary tumor, the presence and scope of inguinal lymph node metastasis affect the prognosis of penile cancer

Protocol

This study was approved by the Institutional Review Board of Hainan Provincial People's Hospital, and all participants provided written informed consent.

1. Patient evaluation

1. Enroll patients for the study who have received inguinal lymph node dissection for penile cancer between 1994 and 2022 using the following criteria. A total of 21 patients were included, and their clinicopathological and demographic details are shown in Table 1. Ensure the surgeries are conducted by the same surgical team through laparoscopy.
   1. Use the following inclusion criteria:(1) Confirmed pathological d....

Results

The mean age of the included patients was 55 years (range: 31-79 years). The urinary catheter was removed between the 7^th and 8^th day after surgery. The average length of hospital stay after surgery was 14 days. Post-operation, 3 patients experienced necrosis of external genitalia wounds, and 4 patients had lymphatic leakage. Lymphatic leakage was successfully resolved through continued drainage, resulting in a prolonged average stay. All participants underwent laparoscopic groin lymph node dissecti.......

Discussion

The continuous development and improvement of lymph node dissection has improved penile cancer treatment. In this study, the surgical approach was modified to achieve the sequence of superficial and deep lymph node dissection and the preservation of the great saphenous vein, which yielded positive results.

Selection of surgical approach
The best choice between the subcutaneous approach through the lower limb femoral triangle and the subcutaneous abdominal approach for la.......

Materials

Name	Company	Catalog Number	Comments
Laparoscopic system	STORZ	20172226846	The system provides high-definition  images.
Laproscopic trocar	Anhui Aofo Medical Equipment Tech Corporation	20202020172	Disposable laproscopic trocar.
Negative pressure drainage device	Futababra	20150003	This disposable material is suitable for negative pressure  suction of patients.
Ultrasonic scalpel	Ethicon Endo-Surgery, LLC	V94A5C	It is used in endoscopic surgery to control bleeding and minimize thermal damage during soft tissue incision.