Management of aberrant crossing of superficial external pudendal artery during robotic video-endoscopic inguinofemoral lymphadenectomy: a video case study.

Inguinofemoral lymphadenectomy remains a critical component of staging and treatment for vulvar and penile squamous cell carcinoma. Traditionally performed via an open approach, this procedure is associated with significant morbidity, including lymphocyst formation, chronic lymphedema, and delayed recovery. A minimally invasive alternative, via laparoscopic or robotic platforms, is gaining traction as it is associated with a lower risk of surgical morbidity. However, this approach presents specific technical challenges due to confined dissection planes and limited surgical exposure. This paper highlights a clinically significant vascular variant encountered during robotic inguinofemoral lymphadenectomy, namely the aberrant course of the superficial external pudendal artery (SEPA) as it crosses anterior to the great saphenous vein near the saphenofemoral junction. While typically located beneath the great saphenous vein, this variation places the SEPA at risk of injury during nodal dissection leading to torrential bleeding. We present a stepwise surgical video demonstrating the safe identification, dissection, and ligation of an aberrant SEPA during robotic-assisted video-endoscopic inguinal lymphadenectomy (R-VEIL). The protocol includes systematic nodal mobilization, identification of anatomical landmarks, and vascular control techniques. Recognition and management of SEPA variants are essential to avoid complications and optimize outcomes. Given the rarity of vulvar and penile cancers, this video serves as an educational tool to improve surgical safety and enhance confidence in managing vascular anomalies during minimally invasive groin dissection.