Robotic assisted inguinal lymph node dissection (RAILND) (SIU 2011)

  • uploaded: Sep 18, 2011
  • Views: 1400
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Sep 18, 2011 / Duration: 03:17 / Views: 1400 / 0 comments


Prem N. Dogra


All India Institute of Medical Sciences, New Dehli, India


Introduction and objective:
Penile cancer with inguinal lymph node metastases is a common cancer in India.
Open inguinal lymphadenectomy is the gold standard to treat inguinal lym ph nodes.
We report the use of RAILND in two patients presenting with palpable lymph nodes
which to our knowledge is the first reported case series from India.
Material and m ethods:
The patients were placed in the supine position with the ipsilateral leg abducted and
padded and contralateral leg kept straight. A 2-cm transverse incision was made
approximately 25 cm inferior to the midpoint of inguinal ligament to develop the
subfascial space just deep to Camper’s fascia(as shown in the video). A blunt tip
balloon trocar was used for the midline robotic cam era port (0°).The two robotic
ports(8 cm away from camera port in a triangular fashion) and a 12-mm assistant
port was placed in between the camera and lateral robotic port. The da Vinci S
robotic system was docked at 30° to the contralateral thigh. The surgical approach
simulated the principles of open techniques. The dissected superficial and deep
nodal package were entrapped separately and removed with preservation of
saphenous vein. Tisseel® (Baxter, Deerfield, IL) was applied to the surgical bed
following dissection.
The total operative time was 90 -110 minutes with estimated blood loss of 50- 100
mL. The patient underwent dissection of the contralateral side (right) after 2 days in
the same admission. The patients were discharged home on postoperative day 2
with advice regarding drain care and 1-week course of oral antibiotics. No
postoperative complications developed. The indwelling drain was removed 10 days
after surgery when the output was less than 50 mL/24 hours. Pathologic examination
revealed no metastatic involvement in superficial and deep lymph nodes on left side
while 4 lymph nodes were having metastases on right side in case 1. In case 2 two
lymph nodes were positive for metastases on the left side.
We believe that RAILND is an efficacious and safe procedure with minimal morbidity
and has a place in managing penile carcinoma patients in India. It also opens a new
chapter in the extended use of robotics in urology thus reducing cost and increasing
its m ultidimensional applicability.


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