Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations.
OBJECTIVE
To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the management of patients with indication for inguinal lymphadenectomy.


METHODS
VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port.


RESULTS
A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed.


CONCLUSIONS
Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.
Division of Urology, Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, Denver, Colorado, USA.
Alexandre
A
Pompeo
Marcos
M
Tobias-Machado
Wilson R
WR
Molina
Jarkes
J
Lucio
David
D
Sehrt
Antonio Carlos Lima
AC
Pompeo
Fernando J
FJ
Kim
D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010412:Penile Neoplasms / Q000601:surgery*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*