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Minimally invasive inguinal lymph node dissection: initial experience and reproducibility in a limited resource setting—with technique video

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Abstract

Background

Conventional inguinal lymph node dissection comes with a high wound complication rate which increases hospital stay and may delay adjuvant treatment. Minimally invasive lymph node dissection (MILND) is a novel endoscopic technique which aims to minimize complications of lymphadenectomy. Herein we present our technique and experience with MILND to examine safety, feasibility and reproducibility in a setting of limited resources.

Methods

All patients undergoing MILND in the National Cancer Institute, Cairo were prospectively included following informed consent, IRB and ethical committee approval. Demographics, clinical, pathological data and postoperative complications according to Clavien–Dindo classification were recorded. Footage collected was used to create a step-by-step video demonstrating the technique.

Results

Twenty-seven procedures were included in the study. The most common indications were vulval cancer (44%) and skin melanoma (19%). There were 5 (18%) conversions to open procedure, all of them in the first 10 cases of the learning curve. The median (range) operative time was 120 (45–240) min and there was a trend towards shorter operative time after the first 5 cases. Wound dehiscence occurred in 4 cases (15%). Three of them (11%) required reoperation (grade III). Grade I/II complications in the form of seroma and wound infection occurred in 34%. The median (range) postoperative hospital stay was 2 (1–14). The median (range) number of retrieved lymph nodes was 12 (3–19). No grade III/IV lymphedema was recorded at 90 days after surgery.

Conclusion

MILND is a safe, feasible technique associated with relatively low postoperative wound complications even when performed in a centre with relatively limited resources.

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References

  1. Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, Royal R, Lucci A, Ross MI, Cormier JN (2010) Prospective assessment of postoperative complications and associated costs following Inguinal Lymph Node Dissection (ILND) in Melanoma patients. Ann Surg Oncol 17:2764–2772

    Article  PubMed  PubMed Central  Google Scholar 

  2. Spiess PE, Hernandez MS, Pettaway CA (2009) Contemporary inguinal lymph node dissection: minimizing complications. World J Urol 27:205–212. https://doi.org/10.1007/s00345-008-0324-6

    Article  PubMed  Google Scholar 

  3. Abbott AM, Grotz TE, Rueth NM, Hernandez Irizarry RC, Tuttle TM, Jakub JW (2013) Minimally invasive inguinal lymph node dissection (MILND) for melanoma: experience from two academic centers. Ann Surg Oncol 20:340–345. https://doi.org/10.1245/s10434-012-2545-6

    Article  PubMed  Google Scholar 

  4. Bishoff JT (2012) Endoscopic subcutaneous modified inguinal lymph node dissection for squamous cell carcinoma of the penis. Smith’s textbook endourology, 3rd edn, vol 2. pp 917–923. https://doi.org/10.1002/9781444345148.ch78

  5. Tobias-Machado M, Tavares A, Silva MNR, Molina WR, Forseto PH, Juliano RV, Wroclawski ER (2008) Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol 22:1687–1691. https://doi.org/10.1089/end.2007.0386

    Article  PubMed  Google Scholar 

  6. Jakub JW, Terando AM, Sarnaik A, Ariyan CE, Faries MB, Zani S, Neuman HB, Wasif N, Farma JM, Averbook BJ, Bilimoria KY, Grotz TE, Allred JBJ, Suman VJ, Brady MS, Tyler D, Wayne JD, Nelson H (2017) Safety and feasibility of minimally invasive inguinal lymph node dissection in patients with melanoma (SAFE-MILND): report of a prospective multi-institutional trial. Ann Surg 265:192–196. https://doi.org/10.1097/SLA.0000000000001670

    Article  PubMed  Google Scholar 

  7. Jakub JW, Terando AM, Sarnaik A, Ariyan CE, Faries MB, Zani S, Neuman HB, Wasif N, Farma JM, Averbook BJ, Bilimoria KY, Allred JB, Suman VJ, Grotz TE, Zendejas B, Wayne JD, Tyler DS (2016) Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy: report of a prospective multi-institutional trial. J Am Coll Surg 222:253–260. https://doi.org/10.1016/j.jamcollsurg.2015.11.010

    Article  PubMed  Google Scholar 

  8. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  9. Executive Committee (2016) The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 49(4):170–184

    Google Scholar 

  10. Martin BM, Master VA, Delman KA (2013) Videoscopic inguinal lymphadenectomy for metastatic melanoma. Cancer Control 20:255–260. https://doi.org/10.1177/107327481302000403

    Article  PubMed  Google Scholar 

  11. Faries B, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, Jahkola T, Bowles TL, Testori A, Beitsch PD, Hoekstra HJ, Moncrieff M, Ingvar C, Wouters MWJM, Sabel MS, Levine EA, Agnese D, Henderson M, Dummer R, Rossi CR, Neves RI, Trocha SD, Wright F, Byrd DR, Matter M, Hsueh E, MacKenzie-Ross A, Johnson DB, Terheyden P, Berger AC, Huston TL, Wayne JD, Smithers BM, Neuman HB, Schneebaum S, Gershenwald JE, Ariyan CE, Desai DC, Jacobs L, McMasters KM, Gesierich A, Hersey P, Bines SD, Kane JM, Barth RJ, McKinnon G, Farma JM, Schultz E, Vidal-Sicart S, Hoefer RA, Lewis JM, Scheri R, Kelley MC, Nieweg OE, Noyes RD, Hoon DSB, Wang HJ, Elashoff DA, Elashoff RM (2017) Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 376:2211–2222. https://doi.org/10.1056/NEJMoa1613210

    Article  PubMed  PubMed Central  Google Scholar 

  12. Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, Sunderkötter C, Kaatz M, Schulte KW, Lehmann P, Vogt T, Ulrich J, Herbst R, Gehring W, Simon JC, Keim U, Martus P, Garbe C (2016) Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 17:757–767. https://doi.org/10.1016/S1470-2045(16)00141-8

    Article  PubMed  Google Scholar 

  13. Bartlett EK, Meise C, Bansal N, Fischer JP, Low DW, Czerniecki BJ, Roses RE, Fraker DL, Kelz RR, Karakousis GC (2013) Sartorius transposition during inguinal lymphadenectomy for melanoma. J Surg Res 184:209–215. https://doi.org/10.1016/j.jss.2013.04.033

    Article  PubMed  Google Scholar 

  14. Tauber R, Schmid S, Horn T, Thalgott M, Heck M, Haller B, Kübler H, Autenrieth M, Retz M, Gschwend JE, Maurer T (2013) Inguinal lymph node dissection: epidermal vacuum therapy for prevention of wound complications. J Plast Reconstr Aesthetic Surg 66:390–396. https://doi.org/10.1016/j.bjps.2012.09.030

    Article  Google Scholar 

  15. Sarnaik AA, Puleo CA, Zager JS, Sondak VK (2009) Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Control 16:240–247. https://doi.org/10.1177/107327480901600306

    Article  PubMed  Google Scholar 

  16. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR, Juliano RV, Wroclawski ER (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177:953–958. https://doi.org/10.1016/j.juro.2006.10.075

    Article  PubMed  Google Scholar 

  17. Tobias-Machado M, Tavares A, Molina WR, Forseto PH, Juliano RV, Wroclawski ER (2006) Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes. Int Braz J Urol 32:316–321. https://doi.org/10.1590/S1677-55382006000300012

    Article  CAS  PubMed  Google Scholar 

  18. Delman KA, Kooby DA, Rizzo M, Ogan K, Master V (2011) Initial experience with videoscopic inguinal lymphadenectomy. Ann Surg Oncol 18:977–982. https://doi.org/10.1245/s10434-010-1490-5

    Article  PubMed  Google Scholar 

  19. Martin BM, Etra JW, Russell MC, Rizzo M, Kooby DA, Staley CA, Master VA, Delman KA (2014) Oncologic outcomes of patients undergoing Videoscopic inguinal lymphadenectomy for metastatic melanoma. J Am Coll Surg 218:620–626. https://doi.org/10.1016/j.jamcollsurg.2013.12.016

    Article  PubMed  Google Scholar 

  20. Lasithiotakis K, Maurichi A, Santinami M, Zoras O (2017) The advent of minimally invasive lymphadenectomy in melanoma. Ann Laparosc Endosc Surg 2:122. https://doi.org/10.21037/ales.2017.06.14

    Article  Google Scholar 

  21. Postlewait LM, Farley CR, Seamens AM, Le N, Rizzo M, Russell MC, Lowe MC, Delman KA (2018) Morbidity and outcomes following axillary lymphadenectomy for melanoma: weighing the risk of surgery in the era of MSLT-II. Ann Surg Oncol 25:465–470. https://doi.org/10.1245/s10434-017-6242-3

    Article  PubMed  Google Scholar 

  22. Kumar V, Sethia KK (2017) Prospective study comparing video-endoscopic radical inguinal lymph node dissection (VEILND) with open radical ILND (OILND) for penile cancer over an 8-year period. BJU Int 119:530–534. https://doi.org/10.1111/bju.13660

    Article  PubMed  Google Scholar 

  23. Li M, Wang S, Guo S, Zhang Z (2015) Endoscopic groin lymphadenectomy with a thigh approach to gynecologic malignancies: a retrospective study with 5-year experience. Int J Gynecol Cancer 25:325–330. https://doi.org/10.1097/IGC.0000000000000348

    Article  PubMed  Google Scholar 

  24. Postlewait LM, Farley CR, Diller ML, Martin B, Hart Squires M, Russell MC, Rizzo M, Ogan K, Master V, Delman K (2017) A minimally invasive approach for inguinal lymphadenectomy in melanoma and genitourinary malignancy: long-term outcomes in an attempted randomized control trial. Ann Surg Oncol 24:3237–3244. https://doi.org/10.1245/s10434-017-5971-7

    Article  PubMed  Google Scholar 

  25. Stuiver MM, Westerduin E, Ter Meulen S, Vincent AD, Nieweg OE, Wouters MWJM (2014) Surgical wound complications after groin dissection in melanoma patients—a historical cohort study and risk factor analysis. Eur J Surg Oncol 40:1284–1290. https://doi.org/10.1016/j.ejso.2014.01.019

    Article  CAS  PubMed  Google Scholar 

  26. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S (2013) Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol 64:486–492. https://doi.org/10.1016/j.eururo.2013.02.037

    Article  PubMed  Google Scholar 

  27. Master VA, Jafri SMA, Moses KA, Ogan K, Kooby DA, Delman KA (2012) Minimally invasive inguinal lymphadenectomy via endoscopic groin dissection: comprehensive assessment of immediate and long-term complications. J Urol 188:1176–1180. https://doi.org/10.1016/j.juro.2012.06.038

    Article  PubMed  Google Scholar 

  28. Pahwa HS, Misra S, Kumar A, Kumar V, Agarwal A, Srivastava R (2013) Video Endoscopic Inguinal Lymphadenectomy (VEIL)—a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma. World J Surg Oncol 11:2–7. https://doi.org/10.1186/1477-7819-11-42

    Article  Google Scholar 

  29. Contreras N, Jakub JW (2020) The achilles heel of minimally invasive inguinal lymph node dissection: seroma formation: Seroma MILND. Am J Surg 219:696–700. https://doi.org/10.1016/j.amjsurg.2019.06.010

    Article  PubMed  Google Scholar 

  30. Sommariva A, Pasquali S, Cona C, Ciccarese AA, Saadeh L, Campana LG, Meroni M, Rossi CR (2016) Videoscopic ilioinguinal lymphadenectomy for groin lymph node metastases from melanoma. Br J Surg 103:1026–1031. https://doi.org/10.1002/bjs.10140

    Article  CAS  PubMed  Google Scholar 

  31. Gerken ALH, Dobroschke J, Reißfelder C, Hetjens S, Braun V, Di Monta G, Jakob J, Hohenberger P, Nowak K, Herrle F (2019) Tissue sealants for the prevention of lymphoceles after radical inguinal lymph node dissection in patients with melanoma: a systematic review and individual patient data meta-analysis. J Surg Oncol 119:728–736. https://doi.org/10.1002/jso.25366

    Article  PubMed  Google Scholar 

  32. Bell JG, Lea JS, Reid GC (2000) Complete groin lymphadenectomy with preservation of the fascia lata in the treatment of vulvar carcinoma. Gynecol Oncol 77:314–318. https://doi.org/10.1006/gyno.2000.5790

    Article  CAS  PubMed  Google Scholar 

  33. Zhang X, Sheng X, Niu J, Li H, Li D, Tang L, Li Q, Li Q (2007) Sparing of saphenous vein during inguinal lymphadenectomy for vulval malignancies. Gynecol Oncol 105:722–726. https://doi.org/10.1016/j.ygyno.2007.02.011

    Article  PubMed  Google Scholar 

  34. Chuo CB, Srivastava S (2010) Management of groin seromas with external quilting sutures and open drainage. J Plast Reconstr Aesthetic Surg 63:e551–e552. https://doi.org/10.1016/j.bjps.2009.12.009

    Article  CAS  Google Scholar 

  35. Chen D, Li Z, Song J, Zheng X, Yu A (2016) Systematic review and meta-analysis of the use of quilting to prevent seroma formation after axillary lymphadenectomy. Int J Clin Exp Med 9:760–772

    CAS  Google Scholar 

  36. Grotz TE, Huebner M, Pockaj BA, Perkins S, Jakub JW (2013) Limitations of lymph node ratio, evidence-based benchmarks, and the importance of a thorough lymph node dissection in melanoma. Ann Surg Oncol 20:4370–4377. https://doi.org/10.1245/s10434-013-3186-0

    Article  PubMed  Google Scholar 

  37. Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Quaglino P, Borgognoni L, Solari N, Piazzalunga D, Mascheroni L, Giudice G, Mocellin S, Patuzzo R, Caracò C, Ribero S, Marone U, Santinami M (2014) The number of excised lymph nodes is associated with survival of melanoma patients with lymph nodemetastasis. Ann Oncol 25:240–246. https://doi.org/10.1093/annonc/mdt510

    Article  CAS  PubMed  Google Scholar 

  38. Spillane AJ, Haydu L, McMillan W, Stretch JR, Thompson JF (2011) Quality assurance parameters and predictors of outcome for ilioinguinal and inguinal dissection in a contemporary melanoma patient population. Ann Surg Oncol 18:2521–2528. https://doi.org/10.1245/s10434-011-1755-7

    Article  PubMed  Google Scholar 

  39. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Puleo CA, Coventry BJ, Kashani-Sabet M, Smithers BM, Paul E, Kraybill WG, McKinnon JG, Wang HJ, Elashoff R, Faries MB (2014) Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 370:599–609. https://doi.org/10.1056/NEJMoa1310460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Egger ME, Brown RE, Roach BA, Quillo AR, Martin RCG, Scoggins CR, Stromberg AJ, McMasters KM (2014) Addition of an iliac/obturator lymph node dissection does not improve nodal recurrence or survival in melanoma. J Am Coll Surg 219:101–108. https://doi.org/10.1016/j.jamcollsurg.2014.02.019

    Article  PubMed  Google Scholar 

  41. Romanelli P, Nishimoto R, Suarez R, Decia R, Abreu D, Machado M, Arroyo C, Campolo H, Campos E, Carlos AS, Tobias-Machado M (2013) Video endoscopic inguinal lymphadenectomy: Surgical and oncological results. Actas Urológicas Españolas (English Ed 37:305–310). https://doi.org/10.1016/j.acuroe.2012.11.005

  42. Zendejas B, Jakub JW, Terando AM, Sarnaik A, Ariyan CE, Faries MB, Zani S, Neuman HB, Wasif N, Farma JM, Averbook BJ, Bilimoria KY, Tyler D, Brady MS, Farley DR (2017) Laparoscopic skill assessment of practicing surgeons prior to enrollment in a surgical trial of a new laparoscopic procedure. Surg Endosc 31:3313–3319. https://doi.org/10.1007/s00464-016-5364-1

    Article  PubMed  Google Scholar 

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Acknowledgements

I cannot express enough my gratitude to Dr. Waheed Yosry Gareer, Dr. Sherif Maamoun, Dr. Ahmed Morsy, Dr. Samy Ramzy and Dr. Hisham Anwar for their invaluable clinical support, Dr. Inas Elattar for helping with statistics, Adham Bakry and Lorena Mora for helping with illustrations, Begad Omran for helping with the video, and Dr. Paul Sugarbaker and Dr Charles Balch for their mentoring.

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Authors and Affiliations

  1. Surgical Oncology Department, National Cancer Institute, Cairo University, 27A Baghdad St. Heliopolis, Cairo, Egypt

    Hisham Abdel Mageed, Ihab Saad, Ahmed Mostafa, Tarek Elbaradie, Mohammed Safa & Mohammed Gamil

  2. Department of Surgery, University Hospital of Heraklion, Crete, Greece

    Konstantinos Lasithiotakis

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  1. Hisham Abdel Mageed
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  2. Ihab Saad
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Correspondence to Hisham Abdel Mageed.

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Dr. Hisham Abdel Mageed, Dr. Ihab Saad, Dr. Tarek Elbaradie, Dr. Ahmed Mostafa, Dr. Mohammed Safa, Dr. Mohammed Gamil and Dr. Konstantinos Lasithiotakis have no conflicts of interest or financial ties to disclose.

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Abdel Mageed, H., Saad, I., Mostafa, A. et al. Minimally invasive inguinal lymph node dissection: initial experience and reproducibility in a limited resource setting—with technique video. Surg Endosc 34, 4669–4676 (2020). https://doi.org/10.1007/s00464-020-07813-z

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