Robot-assisted Sentinel Lymph Node Mapping and Inguinal Lymph Node Dissection Using Near-infrared Fluorescence in Vulvar Cancer

The surgical treatment of vulvar cancer has undergone many changes over the last century. The morbidity of open inguinal incisions prompts the search for a minimally invasive approach to lymph node dissection. This study reports the outcomes of 4 patients with vulvar cancer undergoing robotic sentinel lymph node (SLN) mapping and lymph node (LN) dissection with near-infrared fluorescence. From 2015 to 2017, 3 patients with squamous cell carcinoma of the vulva underwent robot-assisted SLN mapping and inguinal LN dissection. One patient with a vulvar melanoma had robotic bilateral SLN mapping only. The da Vinci Xi System with Firefly technology (Intuitive Surgical, Sunnyvale, CA) and indocyanine green radiotracer was used in all cases. Eight groins underwent robot-assisted SLN mapping, 6 of which underwent inguinal LN dissection. The average operating time was 234 minutes with vulvectomy. The mean blood loss was 124 mL. The operative time decreased, and the lymph node yield increased with each case. There were no wound separations or long-term negative outcomes, such as persistent lymphedema or recurrence. This case series of robot-assisted SLN mapping and inguinal lymph node dissection shows the safety and feasibility of this new technique in vulvar cancer. It may be a valid approach to reduce short- and long-term morbidity.