Department of Uro-oncology, Tata Medical Center, Kolkata, India.
Department of Gynecology, Healthcare Global Enterprises Ltd (HCG) Hospital, Kolkata, India.
Asian J Endosc Surg. 2021 Jul;14(3):464-469. doi: 10.1111/ases.12898. Epub 2020 Nov 16.
Video endoscopic inguinal lymphadenectomy (VEIL) improves on open inguinal node dissection because it offers decreased morbidity. In conventional VEIL, port placement is along the long axis of the femur, above the knee joint. In the laparoscopic approach, this placement is fraught with problems because the camera hits the knee, the surgeon must reach over the camera, and sword fighting occurs between the instruments. In the robotic approach, external collisions are likewise not uncommon because of a lack of optimal spacing between the robot's arms. Here, we describe our lateral approach technique that can be used for both laparoscopic and robotic platforms and can help solve the problems presented by conventional VEIL.
A retrospective review was performed to examine the records of all patients who had undergone VEIL at our institution for management of squamous cell carcinoma of the penis. Patients who had undergone lateral VEIL were identified. The clinical factors, surgery details, time to discharge and drain removal, postoperative complications, and nodal pathology were recorded.
A total of 30 VEILs-26 laparoscopic and 4 robotic-were performed by the lateral approach. On clinical examination, none of the patients had clinically palpable nodes. The mean operative time on one side was 100 minutes (range, 80-140 minutes). The blood loss was minimal in all cases, and there were no conversions to open procedures. The mean time to drain removal was 7 days (range, 5-12 days). Two patients developed bilateral lymphoceles.
Lateral VEIL is feasible and can be used as an alternative to conventional VEIL.
视频内镜腹股沟淋巴结切除术（VEIL）优于开放式腹股沟淋巴结清扫术，因为它具有降低发病率的优点。在传统的 VEIL 中，端口放置在股骨的长轴上，位于膝关节上方。在腹腔镜方法中，这种放置存在问题，因为摄像头会碰到膝盖，外科医生必须越过摄像头，并且器械之间会发生剑斗。在机器人方法中，由于机器人臂之间缺乏最佳间距，同样也会经常发生外部碰撞。在这里，我们描述了一种可以用于腹腔镜和机器人平台的侧方入路技术，它可以帮助解决传统 VEIL 带来的问题。
对我院所有因阴茎鳞状细胞癌而行 VEIL 治疗的患者的记录进行了回顾性检查。确定了接受侧方 VEIL 的患者。记录了临床因素、手术细节、出院和引流管拔除时间、术后并发症和淋巴结病理。
通过侧方入路共完成 30 例 VEIL-26 例腹腔镜和 4 例机器人。临床检查时，所有患者均无临床可触及的淋巴结。一侧的平均手术时间为 100 分钟（范围 80-140 分钟）。所有病例的出血量均很少，无中转开放手术。引流管拔除的平均时间为 7 天（范围 5-12 天）。有 2 例患者发生双侧淋巴囊肿。
侧方 VEIL 是可行的，可以作为传统 VEIL 的替代方法。
