Radical Vulvectomy With Tunnel Groin Dissection
A retrograde “tunnel” en bloc groin dissection commenced at the labial-crural fold is described (Fig. 72–1A). The procedure spares conventional inguinal incisions such as the “Texas Longhorn” incision (Fig. 72–1B) or the separate less radical groin incisions (Fig. 72–1C). Advantages include preservation of the groin skin layer, avoidance of incisional groin infection, and lymphedema of the legs. In our experience, operating time and hospitalization are markedly shortened.
This technique approaches easily the vulvar sentinel nodes because the fossa ovalis and the junctions of the femoral and greater saphenous veins are in close proximity to the labial-crural fold. The skin flap is raised from the labial-crural fold (Fig. 72–2) and is developed by sharp and blunt dissection (Fig. 72–3) until the underlying area of the fossa ovalis is reached. Sentinel groin nodes can then be removed from the fossa ovalis with adequate exposure (Fig. 72–4).
A classic en bloc specimen radical vulvectomy with bilateral groin dissection is outlined in Figure 72–5. Covering gauze is stapled over the tumor. The radical vulvectomy incision is started anteriorly. The skin flap is raised (Fig. 72–6) and developed by sharp and blunt dissection (Fig. 72–7). The surgical field is exposed by Deaver retractors. Vessels are transected by an electrosurgical device (Fig. 72–8). The fat pad is dissected from lateral to medial over the femoral triangle (Fig. 72–9).
Photographs show the exposure of the surgical field. The groin skin is exposed for assessment of thickness of the skin flap, although a groin incision is not made (Fig. 72–10). The specimen is rapidly developed from the area above the pubis and inguinal ligaments (Fig. 72–11). Dissection of the nodal fat pad over the femoral triangle is more delicate and is performed in traditional fashion with excellent exposure (Fig. 72–12). Tunnel groin dissection allows adequate surgical resection (Fig. 72–13).
The surgical field is tightly reapproximated (Fig. 72–14
