Open vs Endoscopic Inguinal Lymphadenectomy

Compared with traditional open inguinal lymphadenectomy, endoscopic surgery is associated with fewer wound-related complications. The open procedure requires a long incision in the groin and the creation of skin flaps, increasing the risk of infection, skin breakdown, and fluid collection. In contrast, endoscopic surgery uses small incisions in the thigh, helping preserve the skin over the groin and reduce wound complications. However, it is not suitable for every patient, and the choice of approach depends on the type of cancer, the extent of lymph node involvement, and the patient’s overall condition.

According to Prof. Dr. Sandeep Nayak, a surgical oncologist who has worked on modified endoscopic techniques for inguinal lymphadenectomy, “The groin is an unforgiving place to cut. The skin is thin over the nodes, it folds and it moves, and the open operation puts all of that at risk. Going in through small cuts on the thigh protects the skin. In the right patient, that one change removes many of the wound problems we used to accept. The cancer still has to be cleared completely, though. That comes first.”

The nodes sit just under a thin layer of skin, and open surgery has to lift that skin to reach them.

The skin flap: A large flap is raised off the nodes beneath. Its blood supply is disturbed, and the edges can die back.

The groin itself: Skin folds, moisture and constant hip movement make this a hard place for a wound to heal.

Lymph leakage: Cutting lymph channels lets fluid collect under the skin as a lymphocele or seroma.

Who needs it: Nodes are removed in penile cancer, vulvar cancer and melanoma of the leg when spread is present or likely.

In published open series, wound complications have been reported in roughly one in five to one in two patients. Our page on groin lymph node dissection explains who needs the operation and how it’s planned.

Feature	Open	Endoscopic
Incision and skin	Long groin incision with a raised skin flap	Small cuts on the thigh, groin skin left intact
Wound infection	Higher	Lower in pooled studies
Skin flap necrosis	A recognised risk	Lower in several meta-analyses
Lymphocele and lymphedema	Common	Lymphocele similar, lymphedema lower in some analyses
Hospital stay	Longer	Shorter in pooled data

Wound infection: The clearest difference. Pooled studies show fewer infections after endoscopic surgery.

Skin necrosis: Fewer flap problems in several meta-analyses, since no large flap is raised. One recent review found no significant gap, so the picture isn’t uniform.

Lymph related problems: Lymphocele rates look similar between the two. Lymphedema is lower in some pooled results, not all.

Cancer control: Recurrence looks comparable in studies so far, but the evidence comes from small studies. Bulky nodes or skin involvement usually mean open surgery is still the safer choice.

For a fuller account of the operation itself, see our blog on what groin lymph node dissection involves