RU-2861350-C1 - METHOD FOR INGUINAL-FEMORAL LYMPHADENECTOMY IN PENILE CANCER

RU2861350C1RU 2861350 C1RU2861350 C1RU 2861350C1RU-2861350-C1

Abstract

FIELD: medicine; oncology. SUBSTANCE: invention can be used for treating penile cancer. After performing a classic Duquesne operation, the spermatic cord is mobilised, its sheath is opened, forming a myofascial-fat flap. The femoral vessels and the entire lymph node dissection area are covered with the myofascial-fat flap. The edges of the myofascial-fat flap are fixed with interrupted sutures to the edges of the inguinal ligament superiorly, to the adductor longus muscle medially, to the sartorius muscle laterally, and to the apex of the femoral triangle inferiorly. The internal spermatic fascia surrounding the vas deferens, vessels and nerves is retracted medially. A drain is placed over the myofascial-fat flap, avoiding contact with the femoral vessels. The subcutaneous tissue and skin wound are sutured with separate interrupted sutures, catching the tissue of the myofascial-fat flap in the suture. EFFECT: increased efficiency of performing inguinal-femoral lymphadenectomy, reduced risk of developing postoperative complications. 1 cl, 2 dwg, 1 ex

Inventors

ATDUEV VAGIF AKHMEDOVICH
Lediaev Denis Sergeevich
Sheiykhov Gadzhikerim Islamovich
Kushaev Zaur Kimovich
Danilov Andrei Aleksandrovich
Dyrdik Maksim Borisovich

Dates

Publication Date: 20260505
Application Date: 20251009

Claims (1)

A method of inguinofemoral lymphadenectomy for penile cancer that involves performing Duquesne inguinofemoral lymphadenectomy, characterized in that after removing the lymphatic apparatus of the inguinofemoral region along with the fatty tissue, fascia, and a portion of the great saphenous vein of the thigh, the external spermatic fascia that envelops the entire spermatic cord from the outside is opened, then the muscle that lifts the testicle, covered by the fascia of the same name, is opened and a myofascial-fatty flap is formed; the femoral vessels and the entire lymph node dissection area are covered with a myofascial-fatty flap; the edges of the myofascial-fatty flap are fixed with interrupted sutures to the edges of the inguinal ligament from above, to the long adductor muscle medially, to the sartorius muscle laterally, and to the apex of the femoral triangle from below; The internal spermatic fascia, which envelops the vas deferens, vessels, and nerves, is retracted medially; the drainage is placed over the myofascial-fat flap, avoiding contact with the femoral vessels; the subcutaneous tissue and skin wound are sutured with separate interrupted sutures, capturing the tissue of the myofascial-fat flap in the suture.

Description

The proposed invention relates to medicine, namely to oncology, and can be used to treat penile cancer. The classical technique of inguinofemoral lymphadenectomy (IFL) was described by Duquesne in 1934 [1,2,3]. This operation is accompanied by a significant number of early and late postoperative complications (wound infection, lymphocele, necrosis of the edges of skin flaps, wound dehiscence, erosion and damage to the femoral vessels, leg edema), the incidence of which is 14%-77% [4,5,6,7,8]. To reduce the incidence of complications, various modifications of this operation have been undertaken: various skin incision options, preservation of the great saphenous vein of the thigh, interposition of the sartorius muscle, vacuum therapy, various drainage options, the use of adhesive compositions, various options for tissue dissection and hemostasis. [9,10,11,12]. However, even in modern large studies, the complication rate still remains high and amounts to 21-55%: wound infection (2-43%), skin necrosis (3-50%), lymphostasis (3.1-30%), lymphocele (1.8-26%), seroma (2.4-60%) [13,14,15,16]. In the early 2000s, an endoscopic approach was developed and introduced. The use of videoendoscopic inguinal lymphadenectomy (VEIL) has made it possible to significantly reduce the incidence of wound complications to 5-20% versus 68-70% with standard interventions [17,18]. The main disadvantages of the VEIL method (or a modified operation, lateral videoendoscopic inguinal lymphadenectomy (L-VEIL)) are: an increase in the intervention time compared to open surgery up to 120-180 min and the lack of significant advantages in reducing the duration of lymphorrhea and the incidence of lymphocele formation [19,20], which prevents VEIL (L-VEIL) from becoming widespread. A method of iliofemoral-inguinal lymph node dissection (LIN) is known for metastases of cancer to the inguinal lymph nodes (Patent RU 2531447). The method is performed as follows. Two semi-oval incisions parallel to the inguinal fold are used to dissect the skin and subcutaneous fat from the anterior superior iliac spine to the tendon of the external oblique muscle of the abdomen. The skin and fat flaps are separated upward to the aponeurosis of the external oblique muscle of the abdomen and downward to the middle of Scarpa's triangle. The inguinal ligament is divided, removing the fascia of the external oblique muscle. The prepubic fat is separated, exposing the base of Scarpa's triangle (femoral triangle). The fat is dissected from the anterior superior iliac spine to the middle of the femoral triangle. The confluence of the great saphenous vein and the femoral vein is isolated and skeletonized. The tissue is dissected from the pubic tubercle to the apex of the femoral triangle. This results in a bipedal tissue block composed of the tissue and lymph nodes of the femoral triangle and femoral canal. The block is removed by transecting the pedicles. Next, iliac LAE is performed. However, the disadvantage of this method is the need to perform a traumatic approach during surgery, which leads to deterioration of tissue trophism, prolongs the healing time, and worsens the cosmetic results. A method of ilioinguinal LAE is known (Patent SU 1484344). This method of ilioinguinal LAE, including covering the femoral vessels, is distinguished by the fact that, in order to prevent trophic disorders and postoperative hernias, a pedicled fascia lata graft is sutured to the inguinal ligament, the aponeurosis of the external oblique muscle of the abdomen, the pubic tubercle, and the ligament of the genu gimbernatifida. The sartorius muscle is then mobilized along the outer edge and the adductor longus muscle along the inner edge. These muscles are then sutured together in front of the femoral vessels and fixed to the inguinal ligament. The disadvantage of this method is the high trauma and technical complexity of the operation. A method for performing the endoscopic Duquesne procedure is known (Patent RU 2691849). The method involves making a 10 mm transverse skin incision along the medial surface of the upper and middle thirds of the right and left thighs. A space is created subcutaneously using blunt incision and a balloon dilator (spacemaker) is inserted. The subcutaneous space is enlarged and a 10 mm optical trocar is inserted. Two 5 mm working trocars are then inserted to the right and left of the optical trocar, and the fatty tissue and lymph nodes are mobilized within Scarpa's triangle. A disadvantage of this method is that its use is limited in patients with lymph node metastases, lymph node infiltration, and cicatricial changes in the inguinal tissue. The procedure is longer than open surgery, and there is no advantage in reducing the duration of lymphorrhea or the incidence of lymphocele formation. The technique for performing classical inguinofemoral lymphadenectomy in men described by Joseph Duquesne (Duquesne operation) [21, pp. 527-530] was chosen as a prototype. The Duques