Shanghai First Maternity and Infant Hospital's pioneering approach to treating vulvar cancer

Shanghai's First Maternity and Infant Hospital has successfully performed a single-incision laparoscopic surgery to treat vulvar cancer, marking a significant advancement in the minimally invasive treatment of this rare gynecological malignancy.

The 48-year-old An Xin (pseudonym) developed the vulvar cancer, a relatively rare gynecological tumor. The traditional surgical procedure involves extensive vulvar resection and inguinal lymph node dissection.

In the conventional approach, incisions of about 15 centimeters in length are made on both sides of the groin. Due to the large surgical wounds, patients typically endure prolonged and painful dressing changes.

An visited Professor Wang Yu, president and a chief physician of the hospital, known as the "Cradle of Shanghai" and the "Harbor of Women's Health."

After diagnosis and assessment, Wang reassured her that they will use the most advanced minimally invasive techniques for her surgery.

Wang's team performed a comprehensive vulvar resection combined with single-incision laparoscopy-assisted extraperitoneal inguinal lymph node dissection for An on July 31. 

The two-hour surgery successfully removed the inguinal lymph nodes, preserved the great saphenous vein, featured only a 2-centimeter abdominal incision and resulted in minimal bleeding. 

It marked a precise and minimally invasive approach to treating vulvar cancer. The patient is in rapid recovery now.

Wang explained that vulvar cancer has a low incidence rate, and surgical innovations have been slow to develop. 

In traditional surgical treatment, in addition to resecting extensive vulvar lesions, approximately 15-centimeter incisions on both sides of the groin are needed for lymph node clearance. 

Due to the large wound and poor blood supply to the skin flap, complications such as skin flap necrosis, infection, and lymphatic leakage easily occur, seriously affecting the postoperative recovery and quality of life of patients.

In recent years, a few hospitals have conducted laparoscopic inguinal lymph node dissection through the thigh entrance route, with surgeries performed through three puncture holes on both thighs. While this method has the advantage of minimally invasive surgery, many patients have reported leg pain that affects their mobility.

Shanghai First Maternity and Infant Hospital's gynecologic oncology team utilized the advantages of single-incision laparoscopy and pioneered a single-incision laparoscopy-assisted extraperitoneal bilateral inguinal lymph node dissection procedure.

The procedure operates within a potential space that is considered an anatomical blind spot for ordinary gynecologists. Conducting single-incision laparoscopy in this area not only requires skilled surgical techniques, but also precise identification of the anatomical layers, and proficiency in the distribution of blood vessels, nerves, and lymph nodes.

Using a single incision, which measures only two centimeters below the navel, bilateral inguinal lymph node dissection is completed, offering an aesthetic incision while avoiding the risks of skin flap necrosis and delayed incision healing. 

This innovative application of single-incision minimally invasive technology in vulvar cancer radical surgery showcases the pioneering work of the hospital.

As a leader and advocate for single-incision laparoscopy and single-incision da Vinci surgery robotic system, Wang said that single-incision laparoscopy has become the standard procedure in the gynecologic oncology department at the hospital. 

“The hospital will fully utilize the advantages of single-incision laparoscopy and single-incision da Vinci technology to innovate and develop more precise and minimally invasive treatment methods for the benefit of our patients," she said.