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.

References

1. Joseph E, Brobeil A, Glass F, Glass J, Messina J, DeConti R et al

(1998) Results of complete lymph node dissection in 83 mela-

noma patients with positive sentinel nodes. Ann Surg Oncol

5:119–125

2. Karakousis CP, Driscoll DL (1994) Groin dissection in malignant

melanoma. Br J Surg 81:1771–1774

3. Karakousis CP, Driscoll DL, Rose B, Walsh DL (1994) Groin

dissection in malignant melanoma. Ann Surg Oncol 1:271–277

4. Karakousis CP, Emrich LJ, Driscoll DL, Rao U (1991) Survival

after groin dissection for malignant melanoma. Surgery

109:119–126

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

123

Surg Endosc (2012) 26:3686–3687

DOI 10.1007/s00464-012-2376-3

and Other Interventional Techniques

5. McMasters KM, Wong SL, Edwards MJ, Chao C, Ross MI,

Noyes RD et al (2002) Frequency of nonsentinel lymph node

metastasis in melanoma. Ann Surg Oncol 9:137–141

6. McMasters KM, Wong SL, Edwards MJ, Ross MI, Chao C,

Noyes RD et al (2001) Factors that predict the presence of sen-

tinel lymph node metastasis in patients with melanoma. Surgery

130:151–156

7. Morton DL, Hoon DS, Cochran AJ, Turner RR, Essner R,

Takeuchi H et al (2003) Lymphatic mapping and sentinel lym-

phadenectomy for early-stage melanoma: therapeutic utility and

implications of nodal microanatomy and molecular staging for

improving the accuracy of detection of nodal micrometastases.

Ann Surg 238:538–549 (discussion 49–50)

8. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm

FK et al (1992) Technical details of intraoperative lymphatic

mapping for early-stage melanoma. Arch Surg 127:392–399

9. Reeves ME, Delgado R, Busam KJ, Brady MS, Coit DG (2003)

Prediction of nonsentinel lymph node status in melanoma. Ann

Surg Oncol 10:27–31

10. Spratt J (2000) Groin dissection. J Surg Oncol 73:243–262

11. Tonouchi H, Ohmori Y, Kobayashi M, Konishi N, Tanaka K,

Mohri Y et al (2004) Operative morbidity associated with groin

dissections. Surg Today 34:413–418

12. Wagner JD, Corbett L, Park HM, Davidson D, Coleman JJ,

Havlik RJ et al (2000) Sentinel lymph node biopsy for melanoma:

experience with 234 consecutive procedures. Plast Reconstr Surg

105:1956–1966

13. Wagner JD, Gordon MS, Chuang TY, Coleman JJ III, Hayes JT,

Jung SH et al (2000) Predicting sentinel and residual lymph node

basin disease after sentinel lymph node biopsy for melanoma.

Cancer 89:453–462

14. Ballester M, Chereau E, Coutant C, Darai E, Rouzier R (2011)

Laparoscopic pelvic lymph node dissection. J Vasc Surg

148:e111–e116

15. Jones WO, Cable RL, Gilling PJ (1995) Laparoscopic pelvic

lymphadenectomy for malignant melanoma (case reports). Aust

N Z J Surg 65:765–767

16. Picciotto F, Volpi E, Zaccagna A, Siatis D (2003) Transperitoneal

laparoscopical iliac lymphadenectomy for treatment of malignant

melanoma (clinical trial). Surg Endosc 17:1536–1540

17. Ali-Khan AS, Crundwell M, Stone C (2009) Inguinal lymphad-

enectomy combined with staging endoscopic pelvic node sam-

pling for stage III melanoma. J Plast Reconstr Aesthet Surg

62:1063–1067

18. Delman KA, Kooby DA, Ogan K, Hsiao W, Master V (2010)

Feasibility of a novel approach to inguinal lymphadenectomy:

minimally invasive groin dissection for melanoma. Ann Surg

Oncol 17:731–737

Surg Endosc (2012) 26:3686–3687 3687

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