Video Endoscopic Inguinal Lymphadenectomy: A New Minimally Invasive Procedure for Radical Management of Inguinal Nodes in Patients With Penile Squamous Cell Carcinoma

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Abstract
Video endoscopic inguinal lymphadenectomy is a recently described lymphadenectomy with the same template of the open technique but performed with laparoscopic instruments under video guidance. It was developed to decrease procedure related morbidity while maintaining good oncological results. We report our initial results in a trial comparing video endoscopic inguinal lymphadenectomy with standard inguinal lymphadenectomy. From 2003 to 2005, 10 patients with penile carcinoma who were at high risk for inguinal metastases underwent bilateral inguinal lymphadenectomy. We performed standard lymphadenectomy in 1 limb and video endoscopic inguinal lymphadenectomy on the contralateral side. Perioperative results and followup data were compared. No intraoperative complications occurred. Mean operative time was 92 and 126 minutes for open and endoscopic surgery, respectively (p=0.00002). Despite the small number of patients we noted a decrease in cutaneous complications with video endoscopic inguinal lymphadenectomy (0% vs 50%, p=0.017) and a trend toward decreased overall morbidity with this endoscopic technique (20% vs 70%, p=0.059). The mean number of retrieved and positive lymph nodes were similar for the 2 techniques. At a mean followup of 18.7 months (range 12 to 31) no signs of recurrence or disease progression were noted. In the postoperative period 9 of the 10 patients identified video endoscopic inguinal lymphadenectomy as the preferred technique in terms of surgical morbidity. Video endoscopic inguinal lymphadenectomy is a safe and feasible technique in patients with penile carcinoma and nonpalpable nodes. These preliminary results suggest that video endoscopic inguinal lymphadenectomy may decrease postoperative morbidity without compromising oncological control. Future studies should include the bilateral procedure, longer term followup and a greater number of patients.