Category: Robotic Surgery: New Techniques - Malignant

VS9-2 - Laparoscopic (Robot-assisted) VEIL Video Demonstration & Single centre experience

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Open inguinal lymphadenectomy is a well-established therapeutic and diagnostic option for patients with invasive penile SCC who are at risk of regional and distant metastases. Despite the use of thick skin flaps based on the blood supply superficial to Scarpa’s fascia, perioperative complications of cellulitis, flap necrosis, and leg edema can affect as many as two thirds of patients


We report the use of endoscopic robotic-assisted inguinal lymph node dissections in high risk patients or palpable lymph nodes


Methods :

We reviewed our patient series from 2012 till 2017 which included carcinoma penis and carcinoma of distal urethra and analysed the data set. Our technique of R-VEIL is shown in the video.


A 2-cm mid-thigh incision was made to develop a plane just deep to Camper’s (fatty) fascia. Once a sufficient working space was created to place 3 robotic ports and 1 assistant port, subcutaneous gas was instilled, and the robotic device was docked and used to perform the dissection. The surgical approach replicated the principles of open techniques such that the contents of the femoral canal were dissected to include both superficial and deep lymph nodes in the dissection template.


Results :

A total of 18 patients underwent R-VEIL in this period of 5 years. Mean age was 59.2 years. Eight patients underwent bilateral veil while the rest underwent unilateral. R-PLND was performed in five of the eighteen. The total console time reduced from 230 minutes to less hundred minutes with experience. The mean EBL was 67ml. the average lymphnode yield was around 15 nodes.


Lymphocele was the commonest complication most of which were managed conservatively.


Conclusions :

Early results suggest that this approach is feasible, safe, and affords an appropriate oncological dissection in selected patients. The reduction of local complications and morbidity is the greatest advantage.


 

Yuvaraja Tb

Head of robotic surgery and urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Srivathsan Ramani

Fellow - Robotic Urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Santosh SUBHASH. Waigankar

Post Doctoral Fellow in Urooncology and Robotic Surgery
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India

Dr. Santosh Waigankar is a trained urologist from India who is presently pursuing urooncology and robotic surgery. After completing his training in urology, he decided to venture into subspecialty of urooncology and robotic surgery. He was selected as the first Vattikuti fellow in robotic urooncology in India (2015) and joined Kokilaben Dhirubhai Ambani hospital under the mentorship of Dr. T. B. Yuvaraja. He has been since associated with the department gaining valuable experience in Si and Xi DaVinci setups, as a beside and a console surgeon.

Fueled with curiosity and eagerness to learn he loves to interact with like-minded people across India and all over the world. He believes that gaining professional experience globally helps oneself to improve one’s perspective and broaden one’s approach to managing urological cancers.

He loves research and wants to work in areas as well looking into “unconventional” issues related to urological cancers as a whole e.g. molecular biology and ways to augment treatment outcomes in future. Doing research is his way of reciprocating back to the community.

His first international entry at the European Robotic Urology Society (ERUS 2017) won him the second prize for the best poster submission. The paper analyzed the “measured” outcomes post robotic partial nephrectomies. He has been awarded the scholarship for attending the 38th Société Internationale d'Urologie Congress (SIU 2018), scheduled to be held in Seoul.

He has keen interest in single port robotic surgery and aspires to get trained in the same.

He loves making friends from all walks of life and believes in knowledge sharing to enrich oneself. He is active on social media. He loves blogging and photography and follows cricket, tennis and F1 racing. Balancing between family, friends and professional life has been his priority always.