Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to safely and proficiently perform this procedure.

A select group of melanoma surgeons with no prior MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy, and performed the procedure in the minimally invasive fashion. A proficiency score comprised of lymph node yield, operative time and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure.

Twelve surgeons from ten institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted over the course of the study. The rate of conversion was higher during an individual surgeon’s early experience (18% (9/49), whereas only one procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%, p = 0.038); however, this did not remain significant after controlling for surgeon.

Following a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions and lymph node yield. Eight-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.