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.

Methods :

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.

Results :

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.

Conclusions :

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.

Presenting Author(s)

• PP

  Pedro Passos

  – Urology Resident, Hospital Senhora Oliveira, Guimaraes, Guimaraes, Braga, Portugal

Author(s)

• JP

  Jose Preza-Fernandes

  – Guimaraes, Braga, Portugal
• RV

  Rui Versos

  – Guimaraes, Braga, Portugal