Inguinal Lymphadenectomy

  • Marcos Tobias-Machado
  • Marcio Covas Moschovas


Conventional open inguinal lymphadenectomy is the gold standard for high-risk penile cancer patients. However, large series of this type of surgery reported a high morbidity (at least 50%), especially regarding the skin and lymphatic events.

Video endoscopic inguinal lymphadenectomy is a minimally invasive procedure that reduces dramatically the skin complications, leading to a less morbid procedure.

In this chapter, we revised the pertinent literature, presented our 10 years’ experience and described some tips and tricks to achieve better results and reduce the associated procedure complications.


Inguinal lymphadenectomy VEIL Complications Robotics Penile cancer 


  1. 1.
    Ornellas AA, Seixas AL, de Moraes JR. Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991;146:330–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Ravi R. Morbidity following groin dissection for penile carcinoma. Br J Urol. 1993;72(6):941–5.CrossRefPubMedGoogle Scholar
  3. 3.
    EAU. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: The role and technique of lymph node dissection. BJU Int. 2001;88:473–83.Google Scholar
  4. 4.
    Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson cancer center experience. J Urol. 2002;167(4):1638–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Nelson BA, Cookson MS, Smith JA Jr, Chang SS. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol. 2004;172(2):494–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G. Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol. 2004;45(6):761–5. discussion 765–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Pandey D, Mahajan V, Kannan RR. Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. 2006;93(2):133–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Pompeo AC, Mesquita JL, Junior WA. Staged inguinal lymphadenectomy (SIL) for carcinoma of the penis (CP). A 13 years prospective study of 50 patients. J Urol. 1995;153:246A. Abstract 72.Google Scholar
  9. 9.
    Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. J Urol. 2013;190(6):2086–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson DE, Lo RK. Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology. 1984;24:312–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Parra RO. Accurate staging of carcinoma of the penis in men with nonpal-pable inguinal lymph nodes by modified inguinal lymphadenectomy. J Urol. 1996;155:560–3.Google Scholar
  12. 12.
    d’Ancona CA, de Lucena RG, Querne FA, et al. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol. 2004;172:498–501.CrossRefPubMedGoogle Scholar
  13. 13.
    Coblentz TR, Theodorescu D. Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol. 2002;168:1386–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Tobias-Machado M, Tavares A, Silva MN, Molina WR Jr, Forseto PH, Juliano RV, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22:1687–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, et al. Endoscopic lymphadenectomy for penile carcinoma. J Endourol. 2007;21(4):364–7. discussion 367CrossRefPubMedGoogle Scholar
  16. 16.
    Master V, Ogan K, Kooby D, Hsiao W, Delman K. LEG endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique. Eur Urol. 2009;56(5):821–8. doi: 10.1016/j.eururo.2009.07.003. Epub 2009 Jul 15CrossRefPubMedGoogle Scholar
  17. 17.
    Romanelli P, Nishimoto R, Suarez R, Decia R, Abreu D. Machado: video endoscopic inguinal lymphadenectomy: surgical and oncological results. Actas Urol Esp. 2013;37(5):305–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Clavien P, Sanabria J, Strasberg S. Proposed classification of complication of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.PubMedGoogle Scholar
  19. 19.
    Master VA, Jafri SM, Moses KA, Ogan K, Kooby DA, Delman KA. Minimally invasive inguinal lymphadenectomy via endoscopic groin dissection: comprehensive assessment of immediate and long-term complications. J Urol. 2012;188(4):1176–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Carlos AS, Romanelli P, Nishimoto R, Montoya LM, Juliano CA, Costa RM Jr, Pompeo AC, Tobias-Machado M. Expanded criteria for video endoscopic inguinal lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes. Int Braz J Urol. 2013;39(6):893.CrossRefPubMedGoogle Scholar
  21. 21.
    Josephson DY, et al. Robotic-assisted endoscopic inguinal lymphadenectomy. Urology. 2009;73(1):167–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Angemeier KW, Sotelo R, Sharp DS. In: Campebell-Walsh urology. 11th ed. Elsevier, Chapter 39, Part IV; 2016. pp. 890–906.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Marcos Tobias-Machado
    • 1
  • Marcio Covas Moschovas
    • 1
  1. 1.Department of Urology, ABC Medical SchoolSection of Urologic OncologySão PauloBrazil

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