Robot-assisted Inguinal Lymphadenectomy: Evolution of the technique with the Alexis® Wound Protector/Retractor

Author(s): Gennaro Musi, Gabriele Cozzi, Sara Coppola, Stefano Luzzago, Matteo Ferro, Gian Marco Orsolini, Mattia Luca Piccinelli, Ettore Di Trapani, Francesco Verrecchia, Giovanni Cordima, Ottavio de Cobelli, Elisabetta Pennacchioli, Francesco Alessandro Mistretta.

Introduction: Robot-assisted inguinal lymphadenectomy (RAIL) has been described as a reliable alternative to traditional open surgery. We reported the evolution of our technique for RAIL after introducing the Alexis® wound protector/retractor (AWPR).

Materials and Methods: We reviewed records of six patients who underwent RAIL with the use of the AWPR for penile or integumental tumors. We recorded clinical, surgical and oncologic data. Findings were compared with our robotic historic series, but no statistical analyses could be conducted due to the limited size of population.

Results: Overall median age was 65 years old, and 63% of patients were men. Median operative time for RAIL with AWPR was 225 minutes (interquartile range [IQR] 198-243), lower than that observed in simple RAIL (279; 210- 300). Estimated blood loss was clinically not significant in both groups. Median RAIL with AWPR LN yield was similar to simple RAIL (9 [7-17] vs. 11[8-16], respectively). Similar hospital stay was recorded (3 [3-3] vs. 4 [3-5] days), as well as similar median time to inguinal drain removal 37 vs 32 days (AWPR vs. simple RAIL patients). Neither open conversions, nor intraoperative major complications were reported. In RAIL with AWPR cohort two patients (33.3%) reported a postoperative complication (one skin necrosis and one infected haematoma), similar to those who received simple RAIL. No locoregional relapses or deaths were reported during follow-up.

Conclusions: RAIL with AWPR was confirmed safe, feasible, with adequate lymph nodes yield and comparable complication rate relative to our historic robotic series.