Introduction: Neo-adjuvant chemotherapy followed by radical inguinal lymph node dissection(ILND) along with pelvic lymph node dissection is indicated in patients with bulky or fixed lymph node metastasis or patients with bilateral disease provided they have a stable response to chemotherapy. The robotic data in this scenario is sparse due to rarity of the disease and a steep learning curve. Material and methods: We describe the technical nuances of robotic full template great saphenous vein non preserving ILND in post chemotherapy setting. Standard robotic ports were placed for a Si robot and a sub scarpa’s fascial plane was created using finger as blunt dissector. Only two robotic instruments are used: maryland bipolar forceps and the monopolar hot shear. We start directly with deep ILND by incising the fascia lata. The dissection proceeds from apex of the femoral triangle inferiorly to the inguinal ligament superiorly. The lymph node package was then separated from the Scarpa’s fascia and the lymph node tissues around the spermatic cord was removed. Results: In a cohort of 4 patients(8 groins) the mean console time and blood loss was 153 minutes and 10 ml in each groin respectively. The length of hospital stay was 1 day and the mean duration of closed suction drain was 14 days.There was no ≥Clavien grade 3 complications. The mean lymph node yield in each groin was 14 and none had any recurrences in 1 year follow up. Conclusion: Robotic post chemotherapy bilateral full template ILND with bilateral pelvic lymph node dissection is safe, less morbid with equivalent lymph node yield as compared to open approach.
CAUTION: contains narrated presentation of PowerPoints, Photos, Diagrams and robotic surgery footage, 07:59