5-years experience with Video Endoscopic Inguinal Lymphadenectomy (VEIL): learning curve and technical variations of a new procedure

Summary Introduction. Video endoscopic inguinal lymphadenectomy (VEIL) was de- scribed in clinical arena 5 years ago to duplicate the open template reducing morbidity and without compromising the oncological control. The objective of this report is to review the technical evolution and variations described and report the learning curve aspects obtained by pionners in this period. Matherial and methods. It was performed a search in important data bases including MEDLINE, LILACS, CANCERLIT and GOOGLE considering as key words video endoscopic inguinal lymphadenectomy, penile cancer, inguinal lymphadenectomy, laparoscopy. The technical variations for endoscopic ap- proach described was resumed and critically analysed. Personal experience was utilized to ilustrations of surgical steps and to describe the learning curve data. Results. All technical variations described to open surgery were safe and feasible by endoscopic approach. In terms of reprodutivity preliminary results of a ongoing word wide survey identified that 11 centers already performed VEIL. Operative time of VEIL is greater in the learning curve compared to the the open procedure. When comparing the first 10 and the last 12 procedures there was a small reduction in mean operative time (120 to 105 min), but there were no differences in complication rate. Conclusions. VEIL is a procedure in your infancy. Reduced morbidity and good midterm oncological results are important arguments to growing acceptance of this new minimally invasive option to manage inguinal lym- phnodes in high risk penile cancer patients.