Preventing Complications: Video Assisted Modified Inguinal Lymphadenectomy in Staging Penile Cancer

  • Mário Pereira-Lourenço Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Duarte Vieira-Brito Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Ricardo Godinho Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Pedro Peralta Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Paulo Conceição Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Carlos Rabaça Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Mário Reis Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
  • Amílcar Sismeiro Serviço de Urologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
Keywords: Lymph Node Excision, Penile Neoplasms, Postoperative Complications, Robotic Surgical Procedures, Urologic Surgical Procedures, Male


Modified inguinal lymphadenectomy allows for correct staging in most cases of penile cancer without palpable inguinal lymph nodes. Currently, it is possible to reproduce the classic surgical technique by video assisted surgery, with similar oncological results and smaller rate of complications. In this article, we report the case of a patient with penile cancer subjected to a total penectomy (pT3NxMx), where bilateral video assisted modified inguinal lymphadenectomy (VMIL) was conducted, being described surgical technique of right VMIL. In this article surgical steps are described (patient positioning, blunt dissection of deep Scarpa fascia, identification of anatomical boundaries, identification of femoral vessels, identification and isolation of saphenous vein until the fossa ovalis, excision of lymph nodes and closure). The great advantage of VMIL is the reduction of post-operatory complications, particularly the low rate of wound dehiscence and lower limb edema, allowing for a much quicker recovery when compared with the classical approach.


Download data is not yet available.


1. Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.

2. Christodoulidou M, Sahdev V, Houssein S, Muneer A. Epidemiology of penile cancer. Curr Probl Cancer. 2015;39:126-36.

3. Cindolo L, Spiess PE, Bada M, Chipollini JJ, Nyirády P, Chiodini P, et al. Adherence to EAU guidelines on penile cancer translates into better outcomes: a multicenter international study. World J Urol. 2018 (in press). doi: 10.1007/s00345-018-2549-3.

4. Hughes BE, Leijte JA, Kroon BK, Shabbir MA, Swallow TW, Heenan SD, et al. Lymph node metastasis in intermediate-risk penile squamous cell cancer: a two-centre experience. Eur Urol. 2010;57:688-92.

5. Graafland NM, Lam W, Leijte JA, Yap T, Gallee MP, Corbishley C, et al. Prognostic factors for occult inguinal lymph node involvement in penile carcinoma and assessment of the high-risk EAU subgroup: a two-institution
analysis of 342 clinically node-negative patients. Eur Urol. 2010;58:742-7.

6. Ornellas AA, Kinchin EW, Nóbrega BL, Wisnescky A, Koifman N, Quirino R. Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol.

7. Kumar V, Sethia KK. Prospective study comparing video-endoscopic radical inguinal lymph node dissection (VEILND) with open radical ILND (OILND) for penile cancer over an 8-year period. BJU Int. 2017;119:530-4. doi: 10.1111/bju.13660.

8. Jacobellis U. Modified radical inguinal lymphadenectomy for carcinoma of the penis: technique and results. J Urol. 2003;169:1349-52.

9. Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67:142-50. doi: 10.1016/j.eururo.2014.10.017

10. Pompeo A, Tobias-Machado M, Molina WR, Lucio J, Sehrt D, Pompeo AC, et al. Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy
(veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations. Int Braz J Urol. 2013;39:587-92.

11. Tobias-Machado M, Tavares A, Silva MN, Molina WR, Forseto PH, Juliano RV, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22:1687-91. doi: 10.1089/end.2007.0386.

12. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. 2002;167:1638-42.

13. Leijte JA, Kirrander P, Antonini N, Windahl T, Horenblas S. Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol. 2008;54:161-8. doi: 10.1016/j.eururo.2008.04.016.

14. Tobias-Machado M, Tavares A, Molina WR, Forseto PH, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes. Int Braz J Urol. 2006;32:316-21.

15. Yadav SS, Tomar V, Bhattar R, Jha AK, Priyadarshi S. Video Endoscopic Inguinal Lymphadenectomy vs Open Inguinal Lymphadenectomy for Carcinoma Penis: Expanding Role and Comparison of Outcomes. Urology.
2018;113:79-84. doi: 10.1016/j.urology.2017.11.007.

16. Chaudhari R, Khant SR, Patel D. Video endoscopic inguinal lymphadenectomy for radical management of inguinal nodes in patients with penile squamous cell carcinoma. Urol Ann. 2016;8:281-5. doi: 10.4103/0974-7796.184883.

17. Pahwa HS, Misra S, Kumar A, Kumar V, Agarwal A, Srivastava R. Video Endoscopic Inguinal Lymphadenectomy (VEIL)--a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma. World J Surg Oncol. 2013;11:42. doi: 10.1186/1477-7819-11-42.

18. Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G. Morbidity of in- guinal lymphadenectomy for invasive penile carcinoma. Eur Urol. 2004;45:761-5; discussion 5-6.

19. Nelson BA, Cookson MS, Smith JA, Chang SS. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol. 2004;172:494-7.

20. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009;55:1075-88.

21. Catalona WJ. Re: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. 1988;140:836.

22. Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet. 1948;87:679-94.

23. Sommariva A, Pasquali S, Rossi CR. Video endoscopic inguinal lymphadenectomy for lymph node metastasis from solid tumors. Eur J Surg Oncol. 2015;41:274-81. doi: 10.1016/j.ejso.2014.10.064.

24. Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CP, et al. Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int. 2013;111:1068-74. doi: 10.1111/j.1464-410X.2012.11729.x.

25. Yuan P, Zhao C, Liu Z, Ou Z, He W, Cai Y, et al. Comparative study of video endoscopic inguinal lymphadenectomy through a hypogastric vs leg subcutaneous approach for penile cancer. J Endourol. 2018;32:66-72. doi: 10.1089/end.2017.0455.

26. Carlos AS, Romanelli P, Nishimoto R, Montoya LM, Juliano CA, Costa RM, et al. Expanded criteria for video endoscopic inguinal lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes. Int Braz J
Urol. 2013;39:893; discussion 4.
Case Report