Sevilla
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The Virgen del Rocío Hospital in Seville has successfully performed the first laparoscopic advanced penile cancer operation and is considering implementing this technique in a general way in a patology in which traditional surgery sometimes involves up to a month of hospitalization for operated patients for hemarroids and risk of infections.
The minimally invasive technique in question is called «video endoscopia inguinal» and consists of the removal of the inguinal nodes (the first place where metastases appear in patients who suffer from penile cancer) by introducing a small camera into the patient’s leg and creating a surgical working space between the muscle plane and the patient’s skin.
The procedure described for the first time in 2006 by the Brazilian urologist Tobias Machado it has been developed in few Spanish hospitals so far due to the high technical difficulty that the surgeon supposes to work within the limits of the femoral triangle.
This novel surgical access, in addition to providing a vision augmented in 3D that increases the precision of the surgeon, makes it possible to avoid the innumerable complications attributable to the surgical wound caused by the inguinal incision inherent to the classical approach through open surgery, which may be present in up to 58 percent of cases.
Another strategic line for the treatment of penile cancer that has recently been incorporated by the same group of urologists, in collaboration with the Nuclear Medicine service, is the «sentinel node» technique, a technique that enjoys great popularity currently for the treatment of breast cancer, but which may have a place in this condition when selecting those cases where lymphadenectomy (lymph node removal) could have a greater curative potential.
Although penile cancer is a rare disease, with a incidence of one per hundred thousand inhabitants, this pioneering technique in Seville could be applied to other more frequent ailments such as vulvar cancer or melanoma.
«It has always been a very painful surgery for the patient because it was not only to remove the part of the penis that had the tumor or the entire penis, but in many cases it involves removing all the gangrenous tissue around it, which caused very extensive wounds with a surgery that later gave many complications due to lymphatic drainage and wound infection», Says Dr. Rafael Medina, director of the Urology-Nephrology Clinical Unit of the Virgen del Rocío Hospital.
This surgery was performed on January 27 in a 79-year-old man and highlighted the clear commitment of the Unit of Urology of the Virgen del Rocío University Hospital, in which twenty urologists work, all surgeons, for minimally invasive surgery. Seven urologists are dedicated to oncological operations.
This service has performed 159 laparoscopic procedures, of which 87 have been assisted by robots, carried out during the state of health alarm, which endorse the prestigious Sevillian center as a benchmark in the fight against cancer. These procedures have been performed in patients with kidney, prostate and bladder tumor pathology, in addition to nephrectomies performed in the context of living donor kidney transplant program. Urology performs about 576 procedures a year.
Rafael Medina affirms that this type of surgery “by minimizing post-operative pain and the possibility of bleeding significantly reduces the time spent in hospital, thus allowing optimization of resources, issue of greater relevance today due to the Covid pandemic situation 19, which results in availability of beds in the hospital, “he says.
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