Category: Laparoscopy: Lower Tract - Malignant
Introduction & Objective : Metastatic lesions in recurrent prostate cancer (PC) can be detected through Prostate-specific membrane antigen (PSMA)–targeted positron
emission tomography (PET). The feasibility of salvage surgery with intraoperative radioguidance using a gamma probe (99m Tc-PSMA) is a reality
with excelente perioperative results. In this vídeo we presente our technique for laparoscopic inguinal lymphadenectomy for removal of recurrent PC
lesion in a unusual location.
The authors presente a case of a 65 year old male, with a rising prostate specific antigen (PSA) three years after radical prostatectomy (RP) and adjuvante radiotherapy (RT). His last PSA measure was of 2.1 ng/mL in December 2017. Both bone scintilography and abdominalpelvic computed tomography (CT) could not identify any metastatic lesion. With 68Ga-PSMA PET-CT it was possible to visualize an 11x8 mm lymph node (LN) in an unusual location - in the upper right inguinal region close to the inguinal ligament. This was confirmed to be a metatases by aspirative citology.
We propose to the patient a salvage surgery, trough right laparoscopic inguinal lymphadenectomy with intraoperative radioguidance aid using a gamma probe (performed after intravenous application of 99m Tc-PSMA).
The authors present a vídeo showing a right laparoscopic inguinal lymphadenectomy using a three-port technique.
Right laparoscopic inguinal lymphadenectomy was carried out easily and quickly. The radioguidance allowed to identify and clarify the affected LN to be removed without any iatrogenic effects. The patient had a 2 day pos-operative hospital recovery without any complication recorded.
This study demonstrates the feasibility and safety of a successful laparoscopic inguinal lymphadenectomy which can also provides support for the use of this technique in other clinical situations.
Hospital Senhora Oliveira, Guimaraes
Guimaraes, Braga, Portugal
4th year Urology Resident from Hospital Senhora Oliveira in Guimarães, Portugal.