Ln in ca penis

inguinal lymph node dissection

1. Inguinal Node Dissection Dr G Praveen C handra

2. Broder’s grading

3. Inguinal anatomy

4. SLNB- Cabanas-1977

5. DSNB

6. Ultrasound Criteria

7. Lymphoscintigraphy : Dynamic images

8. Limits of standard and modified groin dissection

9. Modified inguinal lymphadenectomy-Catalona-1988

10. Key aspects of the procedure are S horter skin incision L imitation of the dissection by excluding the area lateral to the femoral artery and caudal to the fossa ovalis P reservation of the saphenous vein & E limination of the need to transpose the Sartorius muscle.

11. R ight inguinal region after modified lymphadenectomy

12. Palpable Inguinal Adenopathy or Positive Inguinal Nodes

13. Radical Inguinofemoral Lymph Node Dissection

14. Ilioinguinal lymph node dissection

15. Initial dissection for radical IFLND

16. A fter saphenous-sparing, radical, left IFLND

17. P acket will remain in continuity with the pelvic dissection in the area of the femoral canal

18. A fter right radical IFLND

19. Sartorius transposition

20. Closure Primary closure …… .usually possible If large area of inguinal soft tissue sacrificed, primary closure may be obtained by scrotal skin rotation flaps, a bdominal wall advancement flap myocutaneous flap based on the rectus abdominis or tensor fasciae latae

21. Post-op Bed rest for 2 or 3 days Pneumatic compression stockings are used. D rains are removed after 5 to 7 days, when drainage is less than 30 to 40 mL/ day. S uppressive dose of a cephalosporin for 1 to 2 months.

22. Complications Minor ( 40-56% of dissections ) lymphocele , wound infection or necrosis lymphedema Major 4-21% of patients Debilitating lymphedema Flap necrosis Lymphocele req. intervent’n DVT PE

23. Thank You