Video Endoscopic Inguinal Lymphadenectomy Via the Vulva Single Incision (VEIL-V)

Abstract

Study Objective

This study evaluates a novel, minimally invasive single-incision technique for vulvar surgery, aimed at improving safety and reducing complications.

Design

A 2cm incision on the standard vulvar incision line serves as the entry for single port endoscopic lymphadenectomy.

Setting

The procedure involves the patient in lithotomy position with the surgeon operating in between the legs.

Patients or Participants

Three patients with vulvar squamous cell carcinoma, FIGO stage Ib or lower, underwent the surgery post ethics approval, with no major contraindications.

Interventions

The surgery involves a single-port insertion through a 2cm incision, with subcutaneous separation by ultrasonic knife to create an anterior workspace AWS. Continue to expand AWS to the inguinal ligament, the outer edge to the medial anterior superior iliac spine, the inner edge is located 2cm from the inner side of the pubic symphysis, and down to the vertex of the femoral triangle. Remove the lymph nodes around the great saphenous vein, give top priority to the protection of the branches of the great saphenous vein. Expose the sartorius muscle, to make the femoral triangle clear, and completely remove the superficial inguinal lymph nodes. Incise the saphenous vein hiatus resect the lymph nodes between the femoral artery and vein, as well as deep inguinal lymph nodes.

Measurements and Main Results

The surgery duration was 60 minutes with a blood loss of about 10ml. Pathologically, the margins were clear of the tumor, and 13 inguinal lymph nodes were removed without finding metastases.

Conclusion

The single-incision method shortens the operative route and incision length. It ensures precise lymph node removal with enhanced endoscopic visibility, lowers lymphatic and vascular injury risks, and maintains skin integrity at the operative site.