Robotic Ilioinguinal Lymph Node Dissection

(Minimally Invasive Groin Lymph Node Surgery)

What is R-ILND?

Robotic Ilioinguinal Lymph Node Dissection (R-ILND) is a specialized surgical procedure to remove lymph nodes from the groin (inguinal) and pelvic (iliac) areas.

It is primarily performed to treat or stage cancers that have spread—or are at high risk of spreading—to these lymph nodes, most commonly:

Penile Cancer

Melanoma (Skin Cancer)

Urethral Cancer

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Why is this surgery necessary?

Cancers in the genital or lower limb region typically spread first to the lymph nodes in the groin. Removing these nodes helps us:

Stage the Cancer: Determine accurately if the cancer has spread.

Cure the Disease: Removing cancerous nodes can stop the disease from spreading further to other organs.

The Robotic Advantage (R-VEIL)

Traditionally, this surgery required a large incision (10–15 cm) in the groin crease. Because this area moves constantly and has many bacteria, open surgery often led to wound breakdown or infection.

The Robotic Approach (R-VEIL - Robotic Video-Endoscopic Inguinal Lymphadenectomy) changes this:

Technique: We make 3 small "keyhole" incisions (1–2 cm) on the thigh, away from the groin crease.

The Benefit: We work under the skin to remove the nodes without making a large cut. This preserves the skin and significantly reduces the risk of wound infection and healing problems.

Precision: The robot provides a high-definition 3D view, allowing us to carefully peel lymph nodes off blood vessels and nerves.

What Happens During Surgery?

Anesthesia: You will be under general anesthesia (completely asleep).

Duration: The surgery typically takes 2 to 3 hours per side.

The Procedure: The surgeon creates a working space under the skin of the thigh. The robotic arms are used to remove the packet of fatty tissue containing the lymph nodes (Inguinal nodes). If needed, the robot can also reach deeper into the pelvis to remove higher nodes (Iliac nodes) through the same small ports.

Drains: At the end of surgery, a small plastic tube (drain) is placed to prevent fluid buildup.

Risks and Complications

While robotic surgery drastically lowers wound risks, some side effects are specific to lymph node removal:

Lymphedema (Leg Swelling):

What is it? The lymphatic system drains fluid from your leg. Removing nodes can interrupt this flow, causing the leg to swell.

Risk: About 20–30% of patients experience some degree of swelling.

Prevention: Wearing compression stockings after surgery is the best way to manage this.

Seroma (Fluid Collection):

Fluid may build up under the skin after the drain is removed. This usually resolves on its own or can be drained with a small needle in the clinic.

Numbness:

You may feel numbness on the front or inner thigh. This is common and usually improves over time as nerves heal.

Recovery: What to Expect

1. Hospital Stay

Most patients go home in 1 to 2 days (compared to 5–7 days for open surgery).

You will be encouraged to walk the same day to prevent blood clots.

2. Drain Care

You will go home with the drain in place. It typically stays for 1 to 3 weeks.

You will be taught how to empty and measure the fluid daily. We will remove it in the clinic once the output is low (usually less than 30–50 ml per day).

3. Activity

Walking: Encouraged immediately.

Driving: Permitted once you are off pain medication and can move your leg comfortably (usually 2 weeks).

Work: Desk jobs: 2 weeks. Active jobs: 4–6 weeks.

⚠️ When to Call the Doctor

Contact us immediately if you experience:

Fever: Temperature higher than 101°F (38.3°C).

Infection: Redness, warmth, or pus around the incision sites.

Leg Issues: Sudden, painful swelling in one calf (sign of a blood clot).

Drain Issues: The drain falls out or stops draining while you still feel fluid sloshing under the skin.