Article Text
Abstract
Introduction Vulvar cancer accounts for about 4% of gynecologic malignancies. Inguinal nodal metastasis is the essential independent prognostic factor. Inguinofemoral lymphadenectomy has a major role in surgical management of early vulvar cancer with prognostic and potentially therapeutic implications. Inguinofemoral lymphadenectomy is a challenging surgical procedure with a high complication rate owing to the devascularization of skin flaps, the disruption of lymphatic afferents, concomitant medical conditions predisposing to poor wound healing. Surgical morbidity is seen in 50%-76% cases. The mortality related to classical lymphadenectomy is as much as 3%.
Description Endoscopic inguinofemoral lymphadenectomy was developed by Bishoff in 2003 by dissecting two cadaveric models and in one patient with stage T3N1M0 penile carcinoma. VEIL is an alternative to reduce the morbidity without compromising the oncologic outcomes. L-VEIL is a minimally invasive procedure duplicating the standard open procedure with less morbidity. A video presentation to describe the technique of L-VEIL in vulvar cancer and discuss the advantages and outcome.
Conclusion/Implications L–VEIL is an attractive minimally invasive technique to do inguinal block dissection in a single sitting in patients with vulvar carcinoma. L-VEIL allows the removal of inguinal lymph nodes within the same limits as in open procedure and potentially reduces surgical morbidity. It is better accepted cosmetically and reduces hospital stay. Long term oncological results are not available. Randomized multi-institutional studies are required to prove its efficacy over open surgery.