Video Endoscopic Inguinal Lymphadenectomy Via the Vulva Single Incision (VEIL-V)
For patients with vulvar cancer requiring inguinal lymph node resection, traditional approaches involve separate incisions [1-4]. This study introduces a novel single-incision vulvar approach that enables deep inguinal node resection with comparable outcomes, reduced surgical trauma, and a simplified operative pathway. This video aims to present the approach and further investigate its safety and efficacy. A tertiary medical center. With ethical approval, three patients with stage IB vulvar cancer [5] underwent this surgical approach. A standardized surgical protocol was implemented as follows: 1. Make a 2 cm incision at the lesion's outer margin and insert a single port to establish pneumoperitoneum. 2. Under endoscopic visualization, an anterior working space was created and extended to the inguinal ligament, with its lateral edge reaching the medial aspect of the anterior superior iliac spine, medial edge 2 cm medial to the pubic symphysis, and inferior edge extending to the apex of the femoral triangle. 3. Excise the Camper's fascia below the inguinal ligament, extending to the saphenous hiatus. Continue to resect lymph nodes from medial to lateral thigh, expose the great saphenous vein, and resect the surrounding lymph nodes. Pay attention to protecting the branches of the great saphenous vein, expose the sartorius muscle, fully expose the femoral triangle, and completely resect the superficial inguinal lymph nodes. 4. Identify femoral vessels, incise the saphenous vein hiatus, and remove the lymph nodes between the femoral artery and vein, including deep inguinal nodes. The modified single-incision inguinal lymphadenectomy and radical vulvectomy took 100 minutes, with approximately 20 mL blood loss. Pathology showed vulvar squamous cell carcinoma, with negative margins. Thirteen unilateral inguinal lymph nodes were removed, with no metastases identified. The single-incision vulvar inguinal lymphadenectomy offers comparable resection to traditional surgery while being more minimally invasive, shortening the surgical pathway, simplifying saphenous hiatus exposure, and facilitating deep inguinal lymph node removal.