Introduction/Background Modifications in Techniques to identify thigh muscles accurately during surgery to improve problems encountered during robotic groin node dissection (Rob-GND)

Methodology Identification of muscles in the anterior upper half of the thigh is of paramount importance for approaching femoral triangle. In open surgery, the incision and landmarks for identifying sartorius are fairly easy in upper third of thigh. Traditional port placement during Rob-GND described so far and practiced is at the junction of middle and lower third of thigh. However Sartorius and Vastus medialis are almost in the same spot in the middle third of the thigh leading to potential muscle miss. Problems encountered in the initial learning curve of Rob-GND with regards to anatomical muscle miss was addressed by rearranging the position of the ports and bringing them higher up around one index finger length below the apex of the femoral triangle. The initial port placement is done with blunt dissection of the space with index finger reaching the apex of the triangle, then the rest of the ports are introduced. So, the dissection starts from apex which helps in identifying sartorius accurately all the time. A 30 degree telescope helps in visualising the apex of the triangle better to remove the nodal tissue enbloc at completion of surgery as the camera is too close to the apex with this technique.

Results Improved techniques led to easy identification of sartorius and standardization of the procedure.

Conclusion Rob-GND is still a novel technique and is being evaluated. Adjustments and improvements in surgical techniques further will help in standardising the procedure for all surgeons in the learning curve.

Disclosures This surgical video was presented at IGCS Conference 2019