Robot-assisted endoscopic inguinal lymphadenectomy:A review of current outcomes

Objective:To review the role of robot-assisted endoscopic inguinal lymphadenectomy(RAIL)in the management of penile cancer.Methods:A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword“robotic”,“inguinal lymph node dissection”,and“penile cancer”.Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor.Results:We identified 23 articles,of note the three largest series that included 102,27,and 20 RAIL in 51,14,and 10 patients,respectively.Saphenous vein was spared in 88.93%of RAIL cases in these series and node yield was 11.42 per groin;35.28%of patients had positive pathological nodes.The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient.The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days;the major complication rate was only 5.31%in these series.The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%.Conclusion:The literature regarding RAIL describes promising results,although it has shorter follow-up and higher costs when compared to historically series from the open approach.Initials series reported lower cutaneous complications compared to conventional approach,without compromising oncological outcomes.However,long-term results and larger trials are crucial to validate those findings.

Surgical technique of video endoscopic inguinal lymphadenectomy via a hypogastric subcutaneous approach

Open inguinal lymphadenectomy is a necessary conventional management for the lower genitourinary malignancies,but the associated morbidity remains an issue for the conventional surgical approach.Video endoscopic inguinal lymphadenectomy via the limb subcutaneous approach （VEIL-L） has recently been reported as a potentially less invasive alternative to the open inguinal lymphadenectomy for patients with some genitourinary malignancies.1-4 The concept of VEIL-L was first described by the French gynecologists.1-2 Since then,this procedure has undergone a few technical changes.The triangular working space can be obtained by introducing the laparoscopic instruments through three1,2,4 or a single working port3 in the limbs.Thus,laparoscopic pelvic lymphadenectomy （LPL） had to be performed with three or more abdominal working ports if the frozen section revealed positive deep inguinal nodes.To avoid the need to operate both through the limb and the abdomen in this situation,a new approach described in this paper should resolve the issue of the number of access routes with the possible better reduction of infection and morbidity from wound breakdown.