Robotic inguinal lymph node dissection by lateral approach

This video was entered by Dr. Tarun Jindal in the 2022 KS International Robotic Surgery Innovation Awards, sponsored by the Vattikuti Foundation. It was featured in the Vattikuti Symposium ‘Humans at the Cutting Edge of Robotic Surgery,’ held in Miami, Florida November 19, 2022.

Here is the Abstract:

Title: Robotic inguinal lymph node dissection by lateral approach
Author: Dr Tarun Jindal, Head and Senior Consultant, Uro-oncology and Robotic
surgery, NH Narayana Superspeciality Hospital, Howrah, India

Introduction: Inguinal lymph node dissection is a morbid procedure. It is associated with an almost 30% risk of wound complications. Video endoscopic inguinal lymph node dissection (VEIL) is a minimally invasive technique that can decrease the morbidity of open groin dissection. The oncological outcomes of VEIL are similar to the open approach. The VEIL can be performed by both, laparoscopic and robotic approaches. The conventional technique of VEIL has certain technical issues like space constraints, external clashing of robotic arms, lack of space for the assistant, clashing of the arms with the knee, etc. We describe our technique of robotic VEIL by the lateral approach which can circumvent all the technical difficulties of a conventional robotic VEIL.

Methods: In the robotic lateral VEIL approach, the ports are placed along the lateral aspect of the thigh hence there is no issue of space constraints and the clashing of the instruments is practically absent. The identification of the saphenous vein is easy and the dissection of the saphenofemoral junction is also more intuitive as compared to the conventional approach. The details of our technique are described in the video.

Results: We have performed 16 robotic lateral VEILs to date. There have been no wound-related complications. The mean hospital stay was 2 days. The mean operative time was 100 minutes for each procedure.

Conclusion: Robotic lateral VEIL is a feasible option for groin lymph node dissection.

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