A review of the literature on videoscopic and robotic inguinal-iliac-obturator lymphadenectomy in patients with cutaneous melanoma

Abstract: Inguinal–iliac–obturator lymph node dissection is essential in the treatment of patients with cutaneous melanoma exhibiting the clinical or radiological involvement of pelvic lymph nodes. The open procedure is associated with elevated mortality rates. Numerous minimally inva-sive approaches have been suggested to mitigate the impact of this surgery on the patient’s quali-ty of life. The preliminary findings of robotic-assisted dissection have been documented in the lit-erature. They demonstrate a decrease in potential issues linked to robotic-assisted treatments as compared to open or video laparoscopic methods. No implications have been reported for long-term oncological outcomes. The present study compares the outcomes in 64 patients with robotic procedures, 187 with videoscopic procedures, and 83 with open pelvic lymph node dissec-tion (PLND). However, the quality of evidence is too low to draw any valid conclusions. The available literature shows that a robotic procedure is feasible and has similar complication rates and oncological outcomes to other methods. The reason for the shorter operative time is not clear, but is associated with lower hospital costs. It is probable that, from a surgeon’s point of view, robotic techniques offer several advantages over videoendoscopic techniques, such as three-dimensional imaging, ergonomic control, and tools that mimic human hand movements. Randomized controlled trials are necessary to validate the benefits of robotic inguinal–iliac–obturator lymph node dissection (RIIOL) compared to videoscopic and open procedures, but the recruitment rate is very low because of the restricted indications for lymph node dissection against the background of the continuously evolving system of therapy.