Laparoscopic Inguinal Lymph Node Dissection
Douglas Ridyard, MD; Michael Lao, MD; Benjamin Ristau, MD, MHA
University of Connecticut, Farmington, CT
Squamous cell carcinoma (SCC) of the penis is a rare cancer with an incidence of 2,380 cases expected in the United States in 2018. The need for inguinal lymph node dissection pivots on pathologic stage of the primary tumor and clinical staging of the lymph nodes. Open inguinal lymph node dissection carries a high morbidity due to local wound complications. Recently, minimally invasive approaches have been used in an effort to decrease wound complications. In this video we demonstrate a minimally invasive surgical approach to inguinal lymph node dissection.
The patient is a 70 year old man initially seen for a penile mass who underwent a partial penectomy. Final pathology demonstrated a pT2NxMx, well-differentiated squamous cell carcinoma of the penis with negative margins. CT scan revealed a 1.3 cm right inguinal lymph node suspicious for metastasis. The patient elected to undergo staged laparoscopic inguinal lymph node dissection starting with the right side.
Operative time was 2.5 hours and the estimated blood loss was 10 cc. Pathology demonstrated 7 lymph nodes excised during the surgery, all of which were negative for metastatic disease. In follow up the patient had a well healing operative site and mild edema of his lower extremity. While contralateral lymph node dissection was recommended, the patient declined. He is currently being followed with cross-sectional imaging.
Laparoscopic inguinal lymph node dissection in the treatment of penile cancer is a minimally invasive alternative to open surgery which has the potential to decrease morbidity and improve recovery time.
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