Introduction/Background*To demonstrate the proper anatomical landmarks and surgical technique for inguinofemoral lymphadenectomy on a live patient.
Methodology This surgical video was recorded at Ankara City Hospital, an ESGO Accredited Gynecologic Oncology Center.
Result(s)*1. The superficial inguinal lymph nodes are located between the Scarpa’s fascia and fascia lata. The deep inguinofemoral lymph nodes are located below the fascia lata medial to the femoral vein.
2. After the groin incision, which is 2cm below the inguinal ligament and parallel to it, the Camper’s fascia is secured by identifying the Scarpa’s fascia.
3. The superficial inguinal lymph nodes are dissected from the craniolateral part to the caudomedial part; between the superficial circumflex iliac vein laterally, superficial external pudendal vein medially, aponeurosis of the external oblique muscle cranially and inferomedial end of the inguinal ligament where it intersects with the adductor longus muscle caudally.
4. When the superficial inguinal lymph nodes are retracted over the facia lata from the craniolateral part, the fossa ovalis is identified at the central part of the incision, which is covered by the cribriform fascia. Besides, during the excision of the superficial nodes at the caudal part of this area, the great saphenous vein passing through the fossa ovalis is identified.
5. After total excision of the superficial inguinal lymph nodes, the cribriform fascia is dissected. The femoral vein is identified below the fascia lata, covered by the femoral sheath between the sartorius muscle laterally and the adductor longus muscle medially. The great saphenous vein drains into the femoral vein, and the deep inguinofemoral lymph nodes, which are located medial to the femoral vein, are dissected. The femoral artery lies at the lateral part of the femoral vein, and the femoral nerve is the most lateral component in the femoral sheath.
6. The deep inguinofemoral lymph nodes cover the base of the great saphenous vein.
7. During excision of the deep inguinofemoral lymph nodes, the deep external pudendal vein should also be kept in mind, which drains into the great saphenous or femoral vein.
Conclusion*The essential anatomy of the superficial inguinal and deep femoral lymph nodes, with Scarpa’s fascia, facia lata of the thigh, and cribriform fascia should be known to perform an inguinofemoral lymphadenectomy.
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