Robot assisted Retroperitoneal, Pelvic and Inguinal Lymphadenectomy-A desperate attempt in a desperate situation

KS Awards Finalist 3: This video is one of the 8- Finalists in consideration for the top three prizes to be announced February 6th, 2021: Robot assisted Retroperitoneal, Pelvic and Inguinal Lymphadenectomy-A desperate attempt in a desperate situation

Dr. Danny Darlington, Dr. Puneet Ahluwalia, Dr. Gagan Gautam Division of Uro-oncology, Max Institute of Cancer Care, Saket, New Delhi, India

Abstract: The video attached is a demonstration of Single sitting Robot assisted Retroperitoneal, Pelvic and Inguinal Lymphadenectomy performed for late onset metachronous metastases from a rare skin adnexal malignancy of the flank. A 57-year-old gentleman presented with enlarged, hard and fixed right inguinal nodes. He had a prior history excision of right flank swelling in 2009 which was reported as adnexal carcinoma of the eccrine type. FDG PET-CT showed enlarged FDG avid retroperitoneal, right pelvic and right inguinal lymphadenopathy. Using the DaVinci Xi robotic system, a concurrent Retroperitoneal Lymph Node Dissection, Right Pelvic Lymph Node Dissection and Right Video-endoscopic Inguinal Lymphadenectomy was performed. The mobile boom of the Xi system coupled facilitated surgery in both the upper and lower quadrants of the abdomen without the need for redocking. However, the VEIL procedure required redocking. Major vascular injuries (IVC, Renal artery, Inferior Mesenteric Artery, Femoral artery) were encountered and dealt with robotically. The console time was 465 minutes. The estimated blood loss was 300 ml. Patient was discharged home on third postoperative day. The robotic approach is a boon to patients as it reduces the morbidity to a greater extent. We have demonstrated that such an extensive surgery can be done using the DaVinci Xi system with less morbidity. Though challenging, the vascular complications can be managed robotically. The importance of a trained and skilled robotic team cannot be under-estimated.

CAUTION: contains narrated presentation of PowerPoints, Photos, Diagrams and robotic surgery footage, 07:58.