Laparoscopic iliac and iliofemoral lymph node resection for melanoma

Don Hoang, Kurt E. Roberts, Edward Teng, Deepak Narayan

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. Laparoscopic iliac node dissection may be a valuable management option because it allows performance of the same procedure as in open surgery 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 appearance. The authors' approach makes use of a laparoscopic technique to offer an alternative to traditionally described lymph node dissection for melanoma. A review of the literature showed few laparoscopic approaches in this context. Jones et al. 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. Delman et al. 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 melanoma. 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 significant 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.