PMC3788168_01
Assistant position for the right inguinal lymphadenectomy, the robot is located at 45  contralateral to procedure.
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The assistant stands lateral to the right leg for right-side dissection, and between the legs for the left side (Figures 1 and 2).
Assistant position for the left inguinal lymphadenectomy, the robot is located at 90  lateral to procedure.
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The assistant stands lateral to the right leg for right-side dissection, and between the legs for the left side (Figures 1 and 2).
Right surgical procedure template. ASIS: anterior superior iliac spine.
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These marks aid in correct trocar placement as well as delineating the extent of dissection (Figures 3 and 4).
Left surgical procedure template.
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These marks aid in correct trocar placement as well as delineating the extent of dissection (Figures 3 and 4).
Guided finger subcutaneous creation of workspace.
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These two primary robotic 8-mm ports are placed with finger-guided techniques, laterally and medially as shown in Figures 5 and 6.
Endoscope subcutaneous workspace creation by sweeping with the lens itself.
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These two primary robotic 8-mm ports are placed with finger-guided techniques, laterally and medially as shown in Figures 5 and 6.
Subcutaneous surface robot vision under Scarpa's fascia flap.
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The aim of this step is to create a superficial subcutaneous flap under Scarpa's fascia (Figure 7).
Dissection boundaries of inguinal lymphadenectomy. SV: saphenous vein; FV: femoral vein.
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The inguinal ligament is usually identified at the end of this dissection as being a transverse structure with white fibres, marking the superior limit (Figure 8). One will be able to spare the saphenous vein in most of the cases, and the small branches of the femoral artery and vein may be clipped and divided (Figure 8).
Steps for nodal dissection package, axial vision. SV: saphenous vein; FV: femoral vein; FA: femoral artery; N: nerve.
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At this point, the superficial and deep planes of dissection join and separate the package from the inguinal ligament (Figures 9 and 10).
Steps for nodal dissection package, lateral vision. SV: saphenous vein; FV: femoral vein.
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At this point, the superficial and deep planes of dissection join and separate the package from the inguinal ligament (Figures 9 and 10).
Deep pelvic node dissection. SV: saphenous vein; FV: femoral vein; FA: femoral artery; N: nerve.
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This should be continued to the level of the femoral canal and until the pectineus muscle is seen to insure complete nodal retrieval (Figure 11).
Placement of elastic compression stockings, showing drain output and Foley catheter.
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In addition, elastic compression stockings were used since the first postoperative day until three months following surgery (Figure 12).