title: Preservation of the saphenous vein during laparoendoscopic single-site inguinal lymphadenectomy: comparison with the conventional laparoscopic technique.
abstract: OBJECTIVE
  To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single-site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes.
  
  
  METHODS
  A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein. All lymphatic tissue in the boundaries of the adductor longus muscle (medially), the sartorius muscle (laterally), 2 cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply) was removed in both surgical techniques. All 24 procedures were performed by one experienced surgeon.
  
  
  RESULTS
  All 24 procedures (12 LESS and 12 conventional endoscopic inguinal lymphadenectomies) were completed successfully without conversion to open surgery. For LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy groups, the mean ± sd operating time was 94.6 ± 14.8 min and 90.8 ± 10.6 min, respectively (P = 0.145). No significant differences in the incidence of postoperative complications (skin-related problems, hecatomb, lower extremity oedema, lymphatic complications and overall complications) were noted between the two groups (P > 0.05). No lower extremity oedema occurred in any limbs of the two groups. No significant differences were observed in either lymph node clearance rate or detection rate of histologically positive lymph nodes (P > 0.05). The patient satisfaction rate with scar appearance and cosmetic results was significantly better in the LESS inguinal lymphadenectomy group than in the conventional endoscopic inguinal lymphadenectomy group of (75 vs 25%; P = 0.039).
  
  
  CONCLUSIONS
  This preliminary study suggests that both LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESS inguinal lymphadenectomy/conventional endoscopic inguinal lymphadenectomy can effectively reduce the incidence of postoperative lower extremity oedema. LESS inguinal lymphadenectomy seems to provide better cosmetic results than conventional endoscopic inguinal lymphadenectomy.
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Jun-Bin
authors.initials: JB
authors.lastname: Yuan
authors.forename: Min-Feng
authors.initials: MF
authors.lastname: Chen
authors.forename: Lin
authors.initials: L
authors.lastname: Qi
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Yang-Le
authors.initials: YL
authors.lastname: Li
authors.forename: Cheng
authors.initials: C
authors.lastname: Chen
authors.forename: Jin-bo
authors.initials: JB
authors.lastname: Chen
authors.forename: Xiong-Bing
authors.initials: XB
authors.lastname: Zu
authors.forename: Long-Fei
authors.initials: LF
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D006119:Groin / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000295:instrumentation / Q000379:methods*; D010412:Penile Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery*
keywords: inguinal lymphadenectomy; laparoendoscopic single-site surgery; penile cancer; saphenous vein