Antenatal diagnosis and management of fetal inguinoscrotal hernia: A case report with literature review.

Primary inguinal hernia is a common pediatric surgical condition with an incidence of 1%-4%, which is higher in male or premature newborns. It is characterized by the protrusion of abdominal contents through inguinal canal in newborns. However, prenatal fetal inguinal hernia is a rare condition because the pressure of amniotic fluid is similar to intra-abdominal pressure. Only 19 English publications were found with 21 reported cases until now. We report belatedly discovered inguinoscrotal hernia at 38+0 weeks' gestation. Usually, the fetal testicular descent begins from 24 to 25 weeks' gestation, and it is found after 32 weeks of gestational age in 97% of the fetuses. Therefore, it is necessary to get into the habit of checking fetal testicles during routine US after at least 32 weeks of gestational age.

Robot-assisted inguinal sentinel lymph node biopsy in primary yolk sac tumor of the vulva.

BACKGROUND: Primary yolk sac tumor (YST) of the vulva is extremely rare and only introduced in case reports [1]. For those, routine inguinal lymph node dissection (LND) in absence of palpable inguinal lymph node is questionable. To avoid complications of inguinal LND, such as lymphedema, inguinal sentinel lymph node biopsy (SLNB) can be considered [2,3]. Since recent studies reported feasibility of robot-assisted inguinal lymphadenectomy [4], we showed the surgical procedures of robot-assisted inguinal SLNB. VIDEO: A 33-year-old woman with vulvar YST was referred. Two 2 cm sized masses were founded in right vulvar area, and lymph node enlargement was detected in only right external iliac area on imaging studies. Thus, we planned robot-assisted surgical treatment including inguinal SLNB using the fluorescent dye indocyanine green (ICG) during surgery for the vulvar YST. First, we performed intradermal and peri-tumoral injection of 1 ml solution including 1.25 mg of ICG at each 2, 5, 7, and 10 o'clock position for the two tumors. Fifteen minutes later, three-arm robotic surgical system was installed on right thigh. Dissecting the subcutaneous space under the Scarpa's fascia towards the inguinal ligament, one fluorescent inguinal sentinel lymph node was identified and excised, which showed no tumor on pathologic examination (Fig. 1). RESULTS: The procedure time was 70 minutes, and she underwent subsequent robot-assisted pelvic and para-aortic lymphadenectomy and wide local excision of the vulva. CONCLUSION: Robot-assisted inguinal SLNB is feasible. It may be an alternative to inguinal LND for avoiding relevant complications in patients with vulvar malignancy.