[Video endoscopic inguinal lymphadenectomy via hypogastric/limb subcutaneous approach for early-stage vulvar cancer].
OBJECTIVE
To describe and compare video endoscopic inguinal lymphadenectomy via hypogastric and limb approach (VEIL-H vs VEIL-L) in patients with invasive vulvar cancer.


METHODS
From March 2011 to August 2013, 7 women with early-stage vulvar cancer were selected for this integrated procedure with a combination of VEIL-H and VEIL-L in bilateral groins.VEIL-L was performed on limb with old surgical scar in ipsilateral hypogastric area of 3 patients and VEIL-H in contralateral limb. Both novel procedures were performed with triple trocars respectively. The boundaries of inguinal lymph node dissection were the same template of open inguinal lymphadenectomy. Preoperative data, surgical techniques and follow-up outcomes were compared.Standard statistical tests were used.


RESULTS
The combination of VEIL-H and VEIL-L was successfully completed in 7 patients without conversion into open surgery. The great saphenous vein was spared in 13 limbs.No difference existed in mean operative duration, average blood loss volume and median total regional lymph nodes removed in two groups. All nodes were confirmed tumor-free. Mean drain duration was (4.7 ± 1.4) days in the VEIL-H group and (2.7 ± 0.9) days in VEIL-L group respectively (P < 0.01). Mean drain volume was (123 ± 55) ml in VEIL-H group and (62 ± 32) ml respectively (P < 0.05). Mean postoperative hospital stay was (8.6 ± 2.2) days.No major intraoperative complications occurred. However, hypercarbia in one patient 1 was completely reversible with hyperventilation.Unilateral great saphenous vein was injured in another one.Regarding postoperative complications, one patient suffered lymphocele in VEIL-H side and another had lymphorrhea through drain orifice in VEIL-L side. During a follow-up period of (19 ± 7) months, there was no disease recurrence so far.


CONCLUSIONS
The combination of VEIL-H and VEIL-L has the reproducibility and therapeutic potentials in the treatment for patients with vulvar cancer. Both minimal invasive techniques are viable. Although short-term results are encouraging, larger series with a longer follow-up are required to fully evaluate the therapeutic efficacy of VEIL-H and VEIL-L.
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Gaowen
G
Chen
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China. Email: wyf2015@163.com.
Yifeng
Y
Wang
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Ying
Y
Wang
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Honglei
H
Zhu
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Xuefeng
X
Wang
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Dongxian
D
Peng
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Jin
J
Yang
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Wei
W
Cheng
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Xuan
X
Li
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Juxiang
J
Xiong
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Zengying
Z
Cui
Department of Obstetrics & Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Ying
Y
Zhu
D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000601:surgery*