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Video-endoscopic groin node dissection: how it works and who it may suit | CION Cancer Clinics
A video-endoscopic inguinal lymphadenectomy, or VEIL, removes the same groin lymph nodes as open surgery, but through a few small cuts on the thigh using a camera. It aims to avoid a long wound in the groin crease, where infection and breakdown are common. Smaller studies are encouraging, but it does not suit everyone and is not offered everywhere. This page explains how it works and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is a video-endoscopic groin node dissection?
- How does it compare with the open operation?
- Who might be considered for it, and who usually is not?
- What happens during and after the operation?
- What does the evidence actually show?
- What do people assume about keyhole groin surgery?
- What do the words in your surgical notes mean?
- Common questions about video-endoscopic groin dissection
The short answer
What is a video-endoscopic groin node dissection?
A video-endoscopic inguinal lymphadenectomy, often shortened to VEIL, removes the same groin lymph nodes as the open operation, but through a few small cuts on the thigh using a camera. The aim is to avoid a long cut across the groin crease, where wounds are most prone to problems.
Why surgeons developed it
The open operation leaves a long wound in a warm, moving fold with thin skin over it. Infection and wound breakdown are common as a result. By working from below, through small cuts away from the crease, the surgeon tries to keep the groin skin intact.
What stays the same
The purpose is unchanged: to remove the nodes and the fatty tissue around them so the pathologist can check them for cancer. Drains are still used, and lymph fluid still collects afterwards. Leg swelling can still happen.
What this page cannot tell you
It cannot tell you whether this approach suits you, or whether it is offered at the centre you are considering. That depends on your cancer, your nodes and the surgeon's experience with the technique. Ask your team directly.
Side by side
How does it compare with the open operation?
Open groin dissection
Video-endoscopic (VEIL)
One longer cut across or along the groin crease
A few small cuts on the thigh, below the crease
Surgeon sees and handles the tissue directly
Surgeon works on a screen with long, thin instruments
Wound problems are a well-known risk
Smaller studies suggest fewer wound problems
Widely practised by surgical oncologists
Offered in fewer centres, and needs specific training
Often shorter to perform
Usually takes longer in theatre
Not sure whether this applies to you?
Ask an oncologistSuitability
Who might be considered for it, and who usually is not?
These are the things a team weighs. They are not a checklist to decide your own case.
Situations where it may be considered
Nodes that are not visibly enlarged, or a positive sentinel node biopsy that means the rest of the groin nodes need removing.
Cancers where it has been studied
- Penile cancer
- Vulval cancer
- Melanoma of the leg
Bulky or fixed nodes
Large nodes, nodes stuck to the skin or to deeper structures, or nodes that have broken through the skin are usually removed by open surgery. The surgeon needs to see and handle them directly.
Previous surgery or radiotherapy
Scarring from an earlier groin operation or radiotherapy can make the tissue layers hard to separate through a camera. The open approach is often safer in this situation.
When the plan may change on the day
If the surgeon cannot work safely through the small cuts, the operation is converted to open surgery. This is a safety decision, not a failure. Ask beforehand how often it happens in their hands.
The operation
What happens during and after the operation?
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Before surgery
You have the usual fitness checks, blood tests and a meeting with the anaesthetist. Tell the team about every medicine you take, including blood thinners, so they can decide what to do with them.
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Anaesthesia
The operation is done under general anaesthesia or an injection in the back that numbs the lower body. You do not feel the surgery.
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Creating the working space
The surgeon makes small cuts on the inner thigh and gently opens a space under the skin, filling it with gas so the camera can see.
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Removing the nodes
The nodes and surrounding fatty tissue are freed with fine instruments and taken out through one of the cuts. The tissue is sent to the laboratory.
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Drain and waking up
A thin drain is left under the skin to carry away lymph fluid. You wake with small dressings on the thigh rather than one long groin wound.
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Going home
Many people go home with the drain still in and are shown how to care for it. It comes out in clinic once the fluid slows down.
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Being straight with you
What does the evidence actually show?
The early results are encouraging but the studies are small. Most come from single centres with surgeons who specialise in the technique, and few directly compare it with open surgery in a fair trial.
What looks better
Studies so far report fewer wound infections and less wound breakdown than the open operation. Some report shorter hospital stays and a quicker return to walking.
What does not seem to change
Lymph collections and leg swelling still happen, because the same nodes and lymph channels are removed. The number of nodes taken out appears similar in experienced hands, but there is less long-term information on whether the cancer control is equal over many years.
Questions worth asking your centre
How many of these operations has the surgeon done? How often do they switch to open surgery partway through? What happens if the pathology shows more nodes are involved than expected? Would they recommend the same approach if it were a member of their own family? The answers matter more than the name of the technique.
Commonly believed
What do people assume about keyhole groin surgery?
"Smaller cuts mean a smaller operation."
The same tissue is removed inside. The cuts on the skin are smaller, but the space under the skin is similar, so fluid, drains and a period of recovery are still part of it.
"With keyhole surgery the leg will not swell."
Leg swelling comes from removing the lymph nodes, not from the size of the cut. The risk of lymphoedema is not removed by this approach, so the same leg care still applies.
"If a centre does not offer it, the care there is behind."
Open groin dissection remains the standard operation in many centres, and it is the right choice in many situations. A team that is experienced and honest about its results matters more than the technique.
"Being switched to open surgery means something went wrong."
Converting is a planned safety step when the camera view is not good enough. Agreeing to it in advance is a normal part of consent for this operation.
On your notes
What do the words in your surgical notes mean?
- Inguinal lymphadenectomy
- Removal of the lymph nodes in the groin, whether by open or camera-guided surgery.
- VEIL
- Video-endoscopic inguinal lymphadenectomy: the camera-guided version done through small cuts on the thigh.
- Ports
- The small tubes placed through the cuts, through which the camera and instruments pass.
- Conversion
- Switching from camera-guided to open surgery during the same operation.
- Node count
- The number of lymph nodes the pathologist finds in the removed tissue. It helps the team judge how complete the dissection was.
Questions we are asked
Common questions about video-endoscopic groin dissection
Is VEIL the same as robotic surgery?
Not exactly. VEIL is usually done with ordinary camera-guided instruments held by the surgeon. Some centres do a similar operation with a robotic system. The idea behind both is the same: removing the nodes through small cuts away from the groin crease. Ask which method your centre means.
Will it hurt less than open surgery?
Some people report less wound pain, because the cuts are smaller and away from the crease. You will still have discomfort in the thigh and groin, and pain relief is given as with any operation. Tell the team if the pain is not controlled.
Will I still have a drain?
Usually yes. Lymph fluid still leaks after the nodes are removed, whatever the approach. The drain carries it away while the space seals. You may go home with it and be shown how to empty it and record the amount.
Can both groins be done in one operation?
In some cases, both sides are done during the same anaesthetic. It depends on the cancer, your fitness and the surgeon's plan. Ask your team whether they plan one side or both, and how that changes recovery.
Does it remove as many nodes as open surgery?
In experienced hands, studies so far suggest a similar number of nodes is removed. The evidence is from smaller studies, and long-term information is more limited. Your pathology report will state how many nodes were found, and your team will explain what that means for you.
Can the deeper pelvic nodes be removed the same way?
The pelvic nodes lie inside the abdomen and are removed through a separate approach, which can also be keyhole. Whether you need them removed depends on what is found in the groin. Your team will explain if that becomes part of the plan.
Is VEIL more expensive?
It can cost more because of the equipment and longer theatre time, but the total also depends on the hospital stay and any complications. Ask for a written estimate. Aarogyasri, CGHS, ECHS, EHS and cashless insurance may cover it, so check your cover first.
How do I decide between the two approaches?
That decision belongs with your treating team, because it depends on your nodes, your cancer and their experience. What you can do is ask why they recommend one approach, what the alternative would involve and what the wound and leg risks are with each.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
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Sources
- National Cancer Institute — Penile Cancer Treatment (PDQ), patient version
- National Cancer Institute — Vulvar Cancer Treatment (PDQ), patient version
- Cancer Research UK — Surgery for vulval cancer
- NHS — Laparoscopy (keyhole surgery)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Groin Lymph Node Dissection: What It InvolvesThe standard open operation explainedSentinel Node Biopsy of the GroinThe smaller test that can come firstWound Breakdown After Groin DissectionThe wound problem this approach tries to reduceChoosing a Surgeon and a CentreQuestions to ask about experience and results
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