Laparoscopic iliac and iliofemoral lymph node resection for melanoma

VIDEO

Laparoscopic iliac and iliofemoral lymph node resectionfor melanoma

Don Hoang • Kurt E. Roberts • Edward Teng •

Deepak Narayan

Received: 29 October 2011 / Accepted: 24 April 2012 / Published online: 12 August 2012

� Springer Science+Business Media, LLC 2012

Abstract Regional lymphadenectomy in the iliac and

groin, originally devised by Basset in 1912, is performed for

the treatment of melanoma metastatic to this lymphatic basin

[1]. Laparoscopic iliac node dissection may be a valuable

management option because it allows performance of the

same procedure as in open surgery [2–13] but with significant

benefits such as decreased operative morbidity due to

decreased surgical trauma, less violation of the abdominal

muscles or the inguinal ligament, reduced postoperative pain,

and increased patient satisfaction with the cosmetic appear-

ance. The authors’ approach makes use of a laparoscopic

technique [14] to offer an alternative to traditionally descri-

bed lymph node dissection for melanoma. A review of the

literature showed few laparoscopic approaches in this con-

text. Jones et al. [15] do not perform the resection en bloc and

do not address the iliofemoral lymph node dissection with a

combined retroperitoneal technique such as the current

authors use. Two authors in the literature use laparoscopy

through a transperitoneal approach, with a piecemeal

removal of nodes [16, 17]. Delman et al. [18] limit their

technique to the inguinal and high femoral basin alone. The

video demonstrates the novel use of a laparoscopic method to

harvest iliac lymph nodes in combination with a minimally

invasive approach to groin dissection for metastatic mela-

noma. After a laparoscopic resection of these nodes, the

authors deliver the iliac nodal contents through the groin

using a minimally invasive approach. This approach is highly

beneficial to the patient. He is able to leave the hospital

significantly earlier than he would have after a traditional

open procedure. He can return to his job as a car mechanic

within 1 week and is metastasis free at the 9-month follow-

up assessment without evidence of lymphocele formation.

The authors do not believe that this technique has any sig-

nificant implication for lymphocele formation compared with

an open procedure because in essence, the same resection is

being performed. A larger prospective series is necessary to

determine lymphocele outcomes.

Keywords Iliac node resection � Laparoscopy �Melanoma � Novel technique � Pelvic and groin dissection

Disclosures Don Hoang, Kurt E. Roberts, Edward Teng, and

Deepak Narayan have no conflicts of interests or financial ties to

disclose.

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Electronic supplementary material The online version of thisarticle (doi:10.1007/s00464-012-2376-3) contains supplementarymaterial, which is available to authorized users.

D. Hoang � E. Teng � D. Narayan (&)

Department of Plastic and Reconstructive Surgery, Yale

University School of Medicine, P.O. Box 208062, New Haven,

CT 06520-8062, USA

e-mail: deepak.narayan@yale.edu

D. Hoang

e-mail: dhoang@alumni.stanford.edu

K. E. Roberts

Department of Gastrointestinal Surgery, Yale University School

of Medicine, New Haven, CT, USA

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Surg Endosc (2012) 26:3686–3687

DOI 10.1007/s00464-012-2376-3

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