I mainly classify myself as an open surgeon. I believe open inguinal lymphadenectomy provide a way for better lymph nodes retrieval and when done rightly, no interruption of cutaneous vasculature is achieved.

Dear Dr. Ahmed Kotb

Thanks for your reply.

In my personal experience, endoscopic approach for removal of the inguinal node (VEIL-L or VEIL-H procedure) should be preferred as first choice for patients affected with the lower genital malignancy. Infactly, some urological centers had confirmed that video endoscopic inguinal lymphadenectomy (VEIL) achieved a lower morbidity than open lymph node dissection in penile cancer patients.

To achieve the minimally invasive concept of “one access approach should resolve two or more procedures” with possible further reduction of associated morbidity, we advocated this novel approach to perform a VEIL via the hypogastric subcutaneous route (VEIL-H), allowing the laparoscopic pelvic procedures to be carried out using the same working ports of VEIL-H in cases with deep inguinal lymph nodes metastasis.

Obviously, the VEIL-H procedure without a large inguinal incision allows better preservation of the skin blood supply and lymphatic drainage. Therefore, potential benefits are: less skin-related complications, less postoperative pain, improved cosmesis, shorter recovery, lower incidence of groin lymphocele and lymphedema.

Some surgical figures will be showed in the attached to demonstrate the characteristics regarding to the OIL, VEIL-L and VEIL-H, respectively.

PS. The address of VEIL-H vs VEIL-L surgical video (procedures performed by Prof. Yifeng Wang): http://dasai.china-obgyn.net/video/112

Best Regards

Dr. Gaowen Chen

I believe that endoscopic inguinal lymphadenectomy (EIL) has a great potential. However I see its main use in non-bulky disease, but still in cases where radical (non-modified) lymphadenectomy is necessary. It is possible find pros and cons for every technique, but EIL is really minimally invasive and I would expect especially rate of skin problems (such as necrosis) and wound infections lower compared to open approach. On the other hand lymphocele formation would be expected similar.

Dear Ahmed Kotb and Petr Macek

VEIL is performed in select patients affected with early-stage vulvar/penile cancer or cutaneous malignancies of the lower extremities. Since this novel technique was first described by Dargent et al. in 1996 and Mathevet, et al. in 2002, several centres have reported the safety and feasibility of the limb subcutaneous approach. Alternatively, the procedure may also be performed successfully via the hypogastric subcutaneous approach.

As for the lymphorrhea and lymphocele, we think that GSV preservation, sealing of lymph vessels as well as elastic compressionin groin area (Fig) would add to the avoidance of lymphatic drain complications, and that is our rationale to deploy the harmonic scalpel to complete the dissection. Obviously, we observed that the duration of vacuum drainage of laparoscopic group is less than open cases. The video in attached shows the process of dissection for palpable inguinal nodes.

I belive most of the time in cases of carcinoma of vulva they come in late stages with enlarged palpable lymphnodes then the approach of open eill be easier,but if the cases of early cases can go with endoscopic removal of  inguinal lymph nodes.