OBJECTIVE: To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single-site inguinal lymphadenectomy (LESSIL) compared with conventional endoscopic inguinal lymphadenectomy (CEIL) on inguinal nodes management.
PATIENTS AND METHODS: Between February and July 2013, total 12 male patients with squamous cell carcinoma of the penis (SCCP) who underwent penectomy were involved in our study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESSIL or CEIL in different sides) with preservation of the saphenous vein. Both LESSIL and CEIL removed all lymphatic tissue in the boundaries of adductor longus muscle (medially), the sartorius muscle (laterally), 2cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply). All of the operations were performed by one experienced surgeon.
RESULTS: All 24 procedures (12 LESSIL and 12 CEIL) were completed successfully without conversion to open surgery. For LESSIL and CEIL groups, the operation time (min) was 94.6 ± 14.8 vs. 90.8 ± 10.6 (P =0.145). No significant differences in the incidence of postoperative complications (skin-related problems, hecatomb, lower extremity edema, lymphatic complications rate and overall complication rate) were noted between the two groups (P >0.05). There was no lower extremity edema happened in any limbs of the two groups. No significant differences were observed in both lymph node clearance rate and detection rate of histologically positive lymph nodes (P >0.05). However, the postoperative patient's satisfaction with scar appearance and cosmetic results of the LESSIL group (75%) was significantly better than those of the CEIL group (25%) (P =0.039).
CONCLUSION: This preliminary study suggests that both LESSIL and CEIL are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESSIL/CEIL can effectively reduce the incidence of posteroperative lower extremity edema. Moreover, LESSIL seems to provide superior cosmetic results than CEIL.
Written by:
Yuan JB, Chen MF, Qi L, Li Y, Li YL, Chen C, Chen JB, Zu XB, Liu LF. Are you the author?
Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China, 410008.
Reference: BJU Int. 2014 Jun 20. Epub ahead of print.
doi: 10.1111/bju.12838
PubMed Abstract
PMID: 24947014
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