Yuan Jun-Bin, Chen Min-Feng, Qi Lin, Li Yuan, Li Yang-Le, Chen Cheng, Chen Jin-bo, Zu Xiong-Bing, Liu Long-Fei
Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
BJU Int. 2015 Apr;115(4):613-8. doi: 10.1111/bju.12838. Epub 2014 Aug 16.
To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single-site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes.
A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein. All lymphatic tissue in the boundaries of the adductor longus muscle (medially), the sartorius muscle (laterally), 2 cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply) was removed in both surgical techniques. All 24 procedures were performed by one experienced surgeon.
All 24 procedures (12 LESS and 12 conventional endoscopic inguinal lymphadenectomies) were completed successfully without conversion to open surgery. For LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy groups, the mean ± sd operating time was 94.6 ± 14.8 min and 90.8 ± 10.6 min, respectively (P = 0.145). No significant differences in the incidence of postoperative complications (skin-related problems, hecatomb, lower extremity oedema, lymphatic complications and overall complications) were noted between the two groups (P > 0.05). No lower extremity oedema occurred in any limbs of the two groups. No significant differences were observed in either lymph node clearance rate or detection rate of histologically positive lymph nodes (P > 0.05). The patient satisfaction rate with scar appearance and cosmetic results was significantly better in the LESS inguinal lymphadenectomy group than in the conventional endoscopic inguinal lymphadenectomy group of (75 vs 25%; P = 0.039).
This preliminary study suggests that both LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESS inguinal lymphadenectomy/conventional endoscopic inguinal lymphadenectomy can effectively reduce the incidence of postoperative lower extremity oedema. LESS inguinal lymphadenectomy seems to provide better cosmetic results than conventional endoscopic inguinal lymphadenectomy.
前瞻性研究腹腔镜单孔（LESS）腹股沟淋巴结清扫术与传统腹腔镜腹股沟淋巴结清扫术治疗腹股沟淋巴结的手术策略及临床疗效。
选取2013年2月至7月间行阴茎切除术的12例阴茎鳞状细胞癌患者纳入本研究。所有12例患者均接受双侧腹股沟淋巴结清扫术（一侧行LESS腹股沟淋巴结清扫术，另一侧行传统腹腔镜腹股沟淋巴结清扫术），并保留大隐静脉。两种手术方式均切除内收长肌（内侧）、缝匠肌（外侧）、腹股沟韧带上方2 cm（上方）、Scarpa筋膜（浅面）和股血管（深面）范围内的所有淋巴组织。所有24例手术均由一名经验丰富的外科医生完成。
所有24例手术（12例LESS腹股沟淋巴结清扫术和12例传统腹腔镜腹股沟淋巴结清扫术）均成功完成，无需中转开放手术。LESS腹股沟淋巴结清扫术组和传统腹腔镜腹股沟淋巴结清扫术组的平均±标准差手术时间分别为94.6±14.8分钟和90.8±10.6分钟（P = 0.145）。两组术后并发症（皮肤相关问题、严重感染、下肢水肿、淋巴并发症及总体并发症）发生率无显著差异（P>0.05）。两组任何肢体均未发生下肢水肿。两组在淋巴结清除率或组织学阳性淋巴结检出率方面均未观察到显著差异（P>0.05）。LESS腹股沟淋巴结清扫术组患者对瘢痕外观和美容效果的满意度明显高于传统腹腔镜腹股沟淋巴结清扫术组（75%对25%；P = 0.039）。
本初步研究表明，LESS腹股沟淋巴结清扫术和传统腹腔镜腹股沟淋巴结清扫术都是腹股沟淋巴结清扫安全可行的手术方式。LESS腹股沟淋巴结清扫术/传统腹腔镜腹股沟淋巴结清扫术期间保留大隐静脉可有效降低术后下肢水肿的发生率。LESS腹股沟淋巴结清扫术似乎比传统腹腔镜腹股沟淋巴结清扫术提供更好的美容效果。
