Inguinal lymph nodes dissection remains the gold standard for the surgery of penile carcinoma, vulval carcinoma that has which is metastasized to the inguinal lymph nodes. Even though, it is related with. Carcinoma is an rare urological tumor and offers to an opportunity for cure in early stage of the disease. Radical inguinal lymphadenectomy is been linked with wound-related risks and vast deal of complications. Many anatomical studies have report the true lymphatic drainage passageway in order to decrease the area of groin dissection. High efficiency has facilitated the radical pelvic or inguinal lymphadenectomy that is only done when there was histological confirmation of nodal involvement.
OPEN INGUINAL LYMPHADENECTOMY:
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Radical dissection of inguinal region is done from the superior margin of the external ring to anterior superior iliac spine, across from the anterior superior iliac spine expanding 20 cm inferiorly and medially to the line drawn beginning the pubic tubercle 15 cm downwards.
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The long saphenous vein was separated, the anterior aspects of femoral vessels were dissected, and then the femoral vessels were covered with the sartorius muscle.
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Therefore, the superficial lymph node in all 5 anatomic zones explained by Daseler and the deep inguinal nodes is dissected.
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Wound infection, , lymphoedema, skin necrosis, wound dehiscence and lymphocele may occur.
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Optimal skin handling and safe dissection of skin flaps is one of the significant aspects in prevention of risks. Skin rotation flaps and myocutaneous flaps were explained for initial wound closure for complex cases.
LAPAROSCOPIC INGUINAL LYMPHADENECTOMY:
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In this procedure inguinal lymph nodes resection were done via laparoscopy.
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3 Trocars are used in the procedure. The first of 10 mm was positioned 3 mm distal to the top of the femoral triangle as observation port and 2 others of 10 mm and 5 mm were located 6 cm medially and laterally to the femoral triangle correspondingly.
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After division of flap, great saphenous vein is use as anatomic landmark, the superficial and deep lymph nodes were dissect step by step. The limitation of dissection was the similar as those of open radical inguinal lymphadenectomy.
