Introduction/Background The standard surgical treatment of vulvar carcinoma < 4 cm in size without clinical or radiological suspicion of lymph node metastases consists of resection of the vulvar tumor with negative margins with mono- or bilateral sentinel lymph node biopsy performed by inguinal incision. The inguinal approach to inguinal lymph node staging is associated with a high rate of post-operative complications such as wound dehiscence, lymphocele, lymphedema, infections, and psychosexual impairment.
Methodology In this video, we present the case of an 83 years-old patient with 2 cm central anterior vulvar squamous carcinoma and in which inguinal sentinel lymph node biopsy was performed with an innovative video-endoscopic approach using indocyanine green. The surgery was carried out in an Italian Comprehensive Cancer Center.
Results The vulvar–vaginal examination under general anaesthesia reported an central anterior vulvar lesion of 2 cm. Indocyanine green (2.5 mg) was injected all around the tumor mass. After placement of a 15mm main trocar distal to the apex of the femoral triangle and two accessory trocars, the procedure began developing the anterior working space. Then, we performed a blunt dissection developed up to the inguinal ligament. The lymphatic tissue was identified from the fascia lata with a combination of blunt and sharp dissection up to the fossa ovalis. Sentinel lymph node was visualized with fluorescence near-infrared detection and then resected.
Conclusion We believe that this approach to inguinal sentinel lymph node identification and excision may be associated with a reduction in incision-related postoperative complications without compromising the ability to effectively identify any lymph node metastases that impact post-operative management and patient prognosis. Prospective randomized clinical trials are needed to clarify whether this type of procedure will replace the inguinal approach to inguinal sentinel lymph node biopsy as the standard technique in the surgical treatment of vulvar carcinoma.
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