Video Endoscopic Inguinal Lymphadenectomy (VEIL) -a prospective critical perioperative assessment of feasibility and mor
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TECHNICAL INNOVATIONS
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Video Endoscopic Inguinal Lymphadenectomy (VEIL) -a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma Harvinder Singh Pahwa1,3*, Sanjeev Misra2, Awanish Kumar1, Vijay Kumar2, Akash Agarwal2 and Rohit Srivastava1
Abstract Background: Inguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications, such as lymphocele, skin loss and infection. Video Endoscopic Inguinal Lymphadenectomy (VEIL) is an endoscopic procedure, and it seems to be a new and attractive approach duplicating the standard open procedure with less morbidity. We present here a critical perioperative assessment with points of technique. Methods: Ten patients with moderate to high grade penile carcinoma with clinically negative inguinal lymph nodes were subjected to elective VEIL. VEIL was done in standard surgical steps. Perioperative parameters were assessed that is - duration of the surgery, lymph-related complications, time until drain removal, lymph node yield, surgical emphysema and histopathological positivity of lymph nodes. Results: Operative time for VEIL was 120 to180 minutes. Lymph node yield was 7 to 12 lymph nodes. No skin related complications were seen with VEIL. Lymph related complications, that is, lymphocele, were seen in only two patients. The suction drain was removed after four to eight days (mean 5.1). Overall morbidity was 20% with VEIL. Conclusion: In our early experience, VEIL was a safe and feasible technique in patients with penile carcinoma with non palpable inguinal lymph nodes. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and potentially reduces surgical morbidity. Keywords: Penile cancer, Inguinal lymphadenectomy, Video-assisted surgery, Video endoscopic inguinal lymphadenectomy (VEIL)
Background Penile carcinoma is an important health problem in several developing countries, including India [1]. Inguinal lymph node involvement is an important cause of morbidity and an important predictive factor for survival in penile cancer patients [2-4]. In high risk patients, elective inguinal lymphadenectomy may offer survival advantage over watchful waiting [5,6]. Elective * Correspondence: [email protected] 1 Department of Surgery, CSM Medical University (Formerly King George’s Medical University), Lucknow 226003, UP, India 3 New Surgical Block, Department Of Surgery, C.S.M.U. (Erst. K.G.M.U.), Lucknow 226005, UP, India Full list of author information is available at the end of the article
inguinal lymphadenectomy is the standard of care for patients with larger tumour size, high histological grade and the presence of lymphovascular invasion [1,6,7]. Studies show that conventional inguinal lymph node dissection is associated with major complications su
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