Video Endoscopic Inguinal Lymphadenectomy in Post Saphenous Vein Graft Harvest (Coronary Artery Bypass) Status

Abstract

Video endoscopic inguinal lymphadenectomy (VEIL), either by the classical or robot-assisted approach, is performed to manage inguinal lymph nodes in penile carcinoma. Coronary artery bypass graft (CABG) is common in the age group affected by penile carcinoma. Saphenous vein graft harvesting (SVGH) is done for CABG and may be associated with scarred subcutaneous planes hindering VEIL. A 65-year-old male was diagnosed with T2 high-grade penile carcinoma. He had undergone CABG eight years ago. He underwent robot-assisted VEIL. The initial subcutaneous space beneath Camper’s fascia was created by finger dissection and further developed by balloon inflation. A small space was made with difficulty to insert the ports. Monopolar shears were used to make a sharp dissection to develop the subcutaneous plane, and scarring was present close to Camper’s fascia. Multiple small venules were visible and managed with bipolar diathermy. The rest of the procedure was performed as usual. The console time and estimated blood loss were higher in the SVGH limb. The drain output was higher on the SVGH side. Both sides had six negative lymph nodes. Minimal skin duskiness was noted on the ipsilateral side, which healed without any sequelae. This is the first documented report of robot-assisted VEIL, post saphenous vein harvest for CABG. It is associated with a slightly longer procedure time and more blood loss, but a satisfactory oncological outcome. This report highlights the feasibility and safety of robot-assisted VEIL in post-CABG saphenous vein harvest status.

Keywords

• penile carcinoma
• video endoscopic inguinal lymphadenectomy
• coronary artery bypass graft