Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2010 Mar;17(3):731-7. doi: 10.1245/s10434-009-0816-7.
Inguinal lymphadenectomy for metastatic melanoma is reported to have a complication rate as high as 50%. Wound dehiscence has been reported to occur in more than half of these patients, and as a result many surgeons routinely use sartorius muscle transposition to protect against the potential for exposed vessels. We report feasibility of minimally invasive inguinal lymphadenectomy intended to minimize wound complications inherent to this procedure.
Five patients with histologically confirmed inguinal metastases from melanoma underwent minimally invasive inguinal lymphadenectomy. Procedures were performed via three ports: one at the apex of the femoral triangle, a second two fingerbreadths medial to the adductors, and the third two fingerbreadths lateral to the sartorius. No inguinal incision was utilized for the purpose of surgery. A standard melanoma dissection was performed through these ports: contents of the femoral triangle and 5 cm up onto the external oblique aponeurosis were removed. To validate this technique, sentinel node biopsy scars were excised to permit visual confirmation of adequate anatomic dissection.
Five patients underwent minimally invasive inguinal lymphadenectomy for metastatic melanoma. Median operative time was 180 (range, 142-223) min, median hospital stay was 1 day, and two patients developed cutaneous erythema but neither suffered wound dehiscence. Median nodal yield was 10 (range, 4-13). Blood loss was <100 ml for all procedures. Median duration of drain usage was 8 (range 7-19) days.
Minimally invasive inguinal lymphadenectomy is feasible for patients with melanoma as demonstrated by nodal yield and visual inspection. This technique may reduce complication rates and wound dehiscence, and the risk of exposed vessels is minimized by eliminating the inguinal incision. This obviates the need for routine sartorius muscle transposition. A prospective, randomized trial comparing the open versus the videoscopic approach is currently in progress.
有报道称，腹股沟淋巴结清扫术治疗转移性黑色素瘤的并发症发生率高达 50%。据报道，超过一半的此类患者会出现伤口裂开，因此许多外科医生通常会使用缝匠肌移位来防止潜在的暴露血管。我们报告了一种微创腹股沟淋巴结清扫术的可行性，旨在最大限度地减少该手术固有的伤口并发症。
5 名经组织学证实患有黑色素瘤腹股沟转移的患者接受了微创腹股沟淋巴结清扫术。手术通过三个端口进行：一个在股三角顶点，第二个位于内收肌内侧两指宽，第三个位于缝匠肌外侧两指宽。手术中不使用腹股沟切口。通过这些端口进行标准的黑色素瘤解剖：股三角内容物和外斜肌腱膜上 5cm 处的内容物被切除。为了验证该技术，切除前哨淋巴结活检瘢痕，以便对充分的解剖分离进行视觉确认。
5 名患者接受了微创腹股沟淋巴结清扫术治疗转移性黑色素瘤。中位手术时间为 180 分钟（范围，142-223 分钟），中位住院时间为 1 天，有 2 名患者出现皮肤红斑，但均未发生伤口裂开。中位淋巴结产量为 10 个（范围，4-13 个）。所有手术的失血量均<100ml。中位引流管使用时间为 8 天（范围 7-19 天）。
微创腹股沟淋巴结清扫术对黑色素瘤患者是可行的，从淋巴结产量和肉眼检查来看。该技术可降低并发症发生率和伤口裂开率，并通过消除腹股沟切口最大限度地降低暴露血管的风险。这避免了常规缝匠肌移位的需要。目前正在进行一项比较开放与腹腔镜方法的前瞻性随机试验。
