Introduction/Background Inguinofemoral lymphoceles are a common postoperative complication after inguinofemoral lymphadenectomy. A wide range of interventional, medical and surgical options are available for the prevention and treatment of inguinofemoral lymphoceles. Yet, this common complication is a challenge for patients as well as physicians. We report here our preliminary experience in the surgical management of a recurrent lymphocele using indocyanine green detection, followed by robotic-assisted closure of the lymphatic leaks.

Methodology Case report: A 59-year-old woman with locally advanced squamous cell carcinoma of the vulva, FIGO IIIc, previous conventional bilateral inguinofemoral lymphadenectomy, tumor resection with posterior hemivulvectomy and partial colpectomy, presented postoperatively with symptomatic therapy-resistant lymphoceles of the groin. Adjuvant radiochemotherapy was in progress during this time. As the standard therapy was not successful and the patient’s quality of life continued to decline, she was offered surgical treatment with ICG detection and subsequent robot-assisted ligation of the leaks as an off-label therapy option.

Results Lymphoceles are a very common complication of lymphadenectomy. The treatment of these lymphoceles is lengthy and frequently unsuccessful. Many patients require repeated transcutaneous punctures. Surgical options include lymphocele excision with ligation of the lymphatics or lymphatic venous shunts. A less invasive surgical therapy option is robot-assisted localization of the leak by means of ICG with subsequent targeted closure, as described in this case report.

Conclusion A symptomatic lymphocele that cannot be treated conservatively may be managed by surgery. Visualization of the leakage by ICG combined with minimally invasive robotic-assisted laparoscopy is a promising therapy option. The case presented here was marked by a protracted course of treatment, but ultimately the outcome was favorable. The pictures and the video are shown in order to share our experience about the safety, feasibility, and usefulness of surgical identification of a leakage of lymphatic fluid after inguinofemoral lymphadenectomy in vulvar cancer using real-time ICG fluorescence.

Disclosures The authors declare that there are no conflicts of interest.