Introduction/Background As per the ESGO 2023 update on guidelines for the management of vulvar cancers, for tumors ≥4 cm and/or in case of multifocal invasive disease, inguinofemoral lymphadenectomy (IFLA) is mandatory. The groin wound breakdown rate after IFLA is 20 – 40% in different studies and is expected to be < 10% if tissues are preserved above the fascia camper.

The current technique is SIMPLE & EFFECTIVE and it differs from contemporary GND in the following aspects:

• As there is no necessity for developing flaps, there is no flap necrosis.

• Dissection is commenced from the Lateral to medial approach, hence there is less risk of vascular injury.

• As the groin incision is small (1.5 – 2 inches), there is minimal groin breakdown.

• The learning curve seems to be small, hence residents can master this technique

Methodology There are 4 essential steps:

Define the femoral triangle, and mark an incision of 1.5 - 2 inches below the inguinal ligament.

Perpendicular dissection is done in the lateral third of the incision till external oblique aponeurosis cranially and sartorius (after incising deep fascia) laterally are exposed, without developing any flaps with relation to camper fascia.

Identification of the femoral artery is done, and dissection is commenced cauda-cranially from the apex of the triangle.

The Sapheno-femoral junction is identified and the rest of the dissection is completed sparing the great saphenous vein if desired. as per plan.

Results Out of 11 GND in 6 patients over a median follow-up period of 10 months (2 – 36), there are no groin breakdown or groin complications and no groin recurrences. The average lymph node yield per groin is 10.

Conclusion The current technique (small incision groin surgery) is safe, effective, easy to master and merits further evaluation in preventing groin morbidity without compromising oncological outcomes.

Disclosures None.