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  • 2885
  • 2014-09-11

Video endoscopic inguinal lymphadenectomy (VEIL) for penile cancer

Epublication WebSurg.com, Sep 2014;14(09). URL:
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This video reports the endoscopic technique used for the dissection of inguinal lymph nodes as complementary treatment for penile cancer. Laparoscopic surgery has been used in iliac and retroperitoneal lymph nodes approaches, as well as for inguinal nodes dissection (video endoscopic) with fewer sequels and faster recuperation, according to conventional surgery indications. This technique is indicated in patients presenting with penile cancer, in the following situations: - after local treatment; - when there is a lymph node mass less than 4cm; - when mobile palpable lymph nodes appear in the postoperative follow-up; - when there are risk factors for the development of inguinal metastasis (clinical stage > T1 or information regarding the initial biopsy such as histological grade > 1, lymphatic or vascular invasion). This operation is performed bilaterally once. This technique duplicates the conventional technique principles, promoting a radical resection of inguinal lymph nodes, regarding the reduction of surgical morbidity. The video demonstrates that this procedure is feasible and safe with encouraging results. References: 1. Bevan-Thomas R, Slaton JW, Pettaway CA: Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 2002;167:1638-42. 2. Barnholtz-Sloan JS, Maldonado JL, Pow-Sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol 2007;25:361-7. 3. Bishoff JA, Lackland AF, Basler JW, Teichman JM, Thompson IM: Endoscopy subcutaneous modified inguinal lymph node dissection (ESMIL) for squamous cell carcinoma of the penis. J Urol 2003:169;Suppl 4:78. 4. Dardour JC, Ktorza T: Endoscopic deep periorbital lifting: study and results based on 50 consecutive cases. Aesthetic Plast Surg 2000;24:292-8. 5. D’Ancona CA, de Lucena RG, Querne FA, Martins MH, Denardi F, Netto NR Jr: Long-term follow-up of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol 2004;172:498-501;discussion 501. 6. Folliguet TA, Le Bret E, Moneta A, Musumeci S, Laborde F: Endoscopic saphenous vein harvesting versus ‘open’ technique. A prospective study. Eur J Cardiothorac Surg 1998;13:662-6. 7. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 2001;88:473-83. 8. Hungerhuber E, Schlenken B, Karl A, et al. Risk stratification in penile carcinoma: 25-year experience with surgical inguinal lymph node staging. Urology 2006;68:621-5. 9. Leijte JA, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol 2007;52:170-7. 10. Machado MT, Tavares A, Molina Jr WR, Zambon JP, Forsetto Jr P, Juliano RV, Wroclawski ER: Comparative study between videoendoscopic radical inguinal lymphadenectomy (VEIL) and standard open lymphadenectomy for penile cancer: preliminary surgical and oncological results. J Urol 2005;173:226, Abst 834. 11. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 1994;151:1244-9. 12. Hegarty PK, Dinney CP, Pettaway CA. Controversies in Ilioinguinal lymphadenectomy. Urol Clin North Am 2010;37:421-34. 13. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol 2009;55:1075-88. 14. Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, Trujillo G, Novoa J, Cornejo F, Finelli A. Endoscopic lymphadenectomy for penile carcinoma. J Endourol 2007;21:364-7;discussion 367. 15. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 2007;177:953-7;discussion 958. 16. Velasquez EF, Melamed J, Barreto JE, Aguero F, Cubilla AL. Sarcomatoid carcinoma of the penis. A clinicopathologic study of 15 cases. Am J Surg Pathol 2005;29:1152-8. 17. Master V, Ogan K, Kooby D, Hsiao W, Delman K. Leg endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique. Eur Urol 2009;56:821-8.