Drs. Delman and Masters Develop Minimally Invasive Groin Dissection
Working under the banner of the multidisciplinary Winship Cancer Institute of Emory University, Emory surgical oncologist Dr. Keith Delman and Emory urologic oncologist Dr. Viraj Master often cross paths and compare notes. When the two surgeons found they shared a deep concern about the extremely high complication rates associated with the traditional, open method of removing cancerous lymph nodes in the groin, they began to discuss the possible ramifications of applying current, modern-day surgical tools to the problem. As their alternative approach took shape, they designed it to be a bilateral procedure that would involve two surgeons with separate endoscopic setups working simultaneously on the same patient.
The new procedure is called videoscopic groin dissection, and Drs. Delman and Masters have performed over 100 of the operations thus far with excellent results. "The minimally invasive advantages are magnified by the fact that two people are doing the procedure," says Dr. Delman. "The operative duration is greatly reduced, there is reduced anesthesia risk, and perhaps most importantly, we can help each other as we work, consult each other about our particular surgical areas, and apply two minds to solving problems rather than just one."
The method features other significant diversions from the standard approach. Patients must be positioned with their legs bent outwards so that the two surgeons can literally fit within the operative field. By adapting a previously described version of the minimally invasive approach to melanoma patients, the large incisions of the past have been replaced with three tiny keyhole slits in the leg through which the endoscopic camera and tools are inserted. Most significantly, instead of just removing the cancerous lymph nodes, Drs. Delman and Master remove all of the lymph nodes and the fat they nest in, effectively cleaning out the groin space beneath the lower part of the abdominal wall, after which the instruments are withdrawn and the keyholes closed.
"Thus far, the procedure is literally transforming the recovery time that this operation used to have associated with it," says Dr. Delman.
As news of the success of videoscopic groin dissection has spread, Dr. Delman and Master have begun teaching the procedure to surgical oncologists from major academic centers in the United States and around the world, which clarifies it as a revolutionary advance in the treatment of patients with presumed cancerous lymph nodes.