Combined endoscopic and open inguinal dissection for malignant melanoma.
BACKGROUND
Positive sentinel node biopsy or clinically/radiologically demonstrable lymph node metastases in patients with malignant melanoma establishes the indication for inguinal dissection. Currently the deep (pelvic) part of the dissection is the subject of lively discussion. For the past 3 years we have been carrying out all pelvic lymph node dissections using an endoscopic extraperitoneal approach in combination with conventional superficial inguinal dissection.


METHODS
In analogy to endoscopic extraperitoneal hernia repair we open the extraperitoneal space with the aid of a dissection balloon and then perform a complete dissection of the para-iliac and obturator lymph nodes. The superficial part of inguinal dissection is then carried out in the conventional manner.


RESULTS
Among a total of 31 consecutive dissections performed on 30 malignant melanoma patients between April 1999 and June 2002 neither intraoperative nor postoperative complications of the endoscopic part of the dissection were observed.


CONCLUSIONS
While enabling better local tumor control as a result of the complete dissection, this modification entailing the use of endoscopic pelvic dissection also appreciably reduces the extent of operative trauma without compromising oncological radicalness or increasing morbidity. We recommend this approach to all surgeons with experience with endoscopic extraperitoneal procedures for use in patients requiring inguinal dissection.
Schneider
Claus
C
Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Hanover Medical School, Roesebeckstrasse 15, 30449 Hanover, Germany. claus.schneider.siloah@klinikum-hannover.de
Brodersen
Jens P
JP
Scheuerlein
Hubert
H
Tamme
Carsten
C
Lippert
Hans
H
Köckerling
Ferdinand
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery