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Leg Endoscopic Groin Lymphadenectomy (LEG Procedure):
Step-by-Step Approach to a Straightforward Technique ::

Surgeons Keith Delman and Viraj Master commissioned a set of illustrations to illustrate this novel surgical technique. Inguinofemoral lymphadenectomy can serve as a diagnostic and potentially therapeutic procedure in a variety of malignancies, including those of the genitalia and the skin. Historically, this procedure was associated with significant morbidity. The LEG procedure is performed endoscopically to dissect both the superficial and deep groin (complete inguinofemoral lymphadenectomy), in a step-by-step manner, with low morbidity, including those patients with obesity and previously treated groins.

Surgical procedure: The femoral triangle was marked. An initial fingers’ breadth–sized incision was made 3 cm below the apex of the femoral triangle. Finger dissection was used to develop the skin flaps at the apex of the triangle out to two additional 10-mm ports. The anterior space was dissected, and, following that, the saphenous vein was transected distally with an endoscopic stapler. The lateral planes on the adductor longus and sartorius muscles were developed, and, finally, the posterior plane was developed, lifting the packet off the fascia lata. Deep femoral nodes were removed as well. The saphenofemoral junction was transected and the packet was removed. A drain was placed.