Introduction: Treatment of patients with penile cancer without palpable inguinal lymph nodes has evolved, with less invasive and less morbidity techniques being used. Modified inguinal lymphadenectomy (excision of medial and central lymph nodes, preserving the saphenous vein) allows for correct staging in most cases, although around 5,5% of pN0 patients present local lymphatic recurrence of the disease. Currently, it is possible to reproduce the classic surgical technique by videoassisted surgery, with similar oncological results and smaller rate of complications.
Methods: Right videoassisted modified inguinal lymphadenectomy video. Patients chart, histologic and biochemistry data analysis.
Results: A 78 years old patient, with initial diagnosis of early stage penile cancer with 6 months since diagnosis, presented a hard and irregular mass that occupied the distal2/3 of the penis, without palpable inguinal masses. Pelvic magnetic resonance identified a neoplastic lesion with 10cm of largest axis with invasion of the urethra, without node invasion. The patient was subject to total penectomy, having histology revealed a squamous cell carcinoma pT3NxMx. After 3 months the patient was subjected to a left VMIL, without complications. Six lymph nodes were removed all negative for metastatic disease. One month after the patient was subjected to a right VMIL without immediate complications, surgery duration was of 2 hours and 14 minutes. The patient was committed for four days. Seven lymph nodes were removed, all without metastatic disease.?The present video refers to the right VMIL, being all the steps of the surgical technique presented (positioning of the patient, trocar placement, dissection of the Scarpa fascia, identification of the anatomical limits, identification of the femoral vessels, identification and isolation of the saphenous vein, excision of lymph nodes and closure).
Conclusions: The greatest advantage of VMIL is the post-operative recovery, with lower rates of wound dehiscence and lower limb edema, allowing for a much quicker recovery when compared with the classical approach. The key aspect of this technique is the creation of a correct dissection plan and clear identification of its limits.
Key-Words: Penile cancer; videoassisted modified inguinal lymphadenectomy; surgery technique.