Leg endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique.
BACKGROUND
Inguinofemoral lymphadenectomy can serve as a diagnostic and potentially therapeutic procedure in a variety of malignancies, including those of the genitalia and the skin. Historically, this procedure was associated with significant morbidity.


OBJECTIVE
We hypothesized that both superficial and deep groin dissection (complete inguinofemoral lymphadenectomy) could be performed endoscopically, in a step-by-step manner, with low morbidity, including those patients with obesity and previously treated groins.


METHODS
Twenty-five groin dissections were undertaken in 16 patients, male and female, over a 12-mo time period.


METHODS
The femoral triangle was marked. An initial fingers' breadth-sized incision was made 3 cm below the apex of the femoral triangle. Finger dissection was used to develop the skin flaps at the apex of the triangle out to two additional 10-mm ports. The anterior space was dissected, and, following that, the saphenous vein was transected distally with an endoscopic stapler. The lateral planes on the adductor longus and sartorius muscles were developed, and, finally, the posterior plane was developed, lifting the packet off the fascia lata. Deep femoral nodes were removed as well. The saphenofemoral junction was transected and the packet was removed. A drain was placed.


METHODS
The number of lymph nodes harvested was recorded. The development of skin complications, leg edema, and deep venous thrombosis was recorded as well.


CONCLUSIONS
The average length of procedure was 147 min. The mean number of lymph nodes harvested was nine. A groin seroma requiring further drainage was observed in one patient. Cellulitis was observed in two patients.


CONCLUSIONS
Leg endoscopic groin lymphadenectomy (LEG procedure) is straightforward to learn, with operative times that parallel the open procedure. Less morbidity has been observed in our first group of patients compared to contemporary open series.
Master
Viraj
V
Department of Urology, Emory University, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA 30322, USA. vmaster@emory.edu
Ogan
Kenneth
K
Kooby
David
D
Hsiao
Wayland
W
Delman
Keith
K
D000328:Adult; D000368:Aged; D002481:Cellulitis / Q000209:etiology; D004322:Drainage; D004487:Edema / Q000209:etiology; D004724:Endoscopy; D005260:Female; D005845:Georgia; D006119:Groin; D006801:Humans; D007866:Leg; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology