Leg Endoscopic Groin Lymphadenectomy (LEG Procedure): Step-by-Step Approach to a Straightforward Technique

Background: Inguinofemoral lymphadenectomy can serve as a diagnostic and potentially therapeutic procedure in a variety of malignancies, including those of the genitalia and the skin. Historically, this procedure was associated with significant morbidity. Objective: We hypothesized that both superficial and deep groin dissection (complete inguinofemoral lymphadenectomy) could be performed endoscopically, in a step-by-step manner, with low morbidity, including those patients with obesity and previously treated groins. Design, setting, and participants: Twenty-five groin dissections were undertaken in 16 patients, male and female, over a 12-mo time period. Surgical procedure: The femoral triangle was marked. An initial fingers' breadth-sized incision was made 3 cm below the apex of the femoral triangle. Finger dissection was used to develop the skin flaps at the apex of the triangle out to two additional 10-mm ports. The anterior space was dissected, and, following that, the saphenous vein was transected distally with an endoscopic stapler. The lateral planes on the adductor longus and sartorius muscles were developed, and, finally, the posterior plane was developed, lifting the packet off the fascia lata. Deep femoral nodes were removed as well. The saphenofemoral junction was transected and the packet was removed. A drain was placed. Measurements: The number of lymph nodes harvested was recorded. The development of skin complications, leg edema, and deep venous thrombosis was recorded as well. Results and limitations: The average length of procedure was 147 min. The mean number of lymph nodes harvested was nine. A groin seroma requiring further drainage was observed in one patient. Cellulitis was observed in two patients. Conclusions: Leg endoscopic groin lymphadenectomy (LEG procedure) is straightforward to learn, with operative times that parallel the open procedure. Less morbidity has been observed in our first group of patients compared to contemporary open series. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.