Introduction: The presence or absence of lymph node metastasis in squamous cell carcinoma of the penis is a key prognostic factor. Despite having the potential to spread to the inguinal lymph nodes, squamous cell carcinoma of the penis is one of the few cancers that can be cured with extirpative nodal surgery. Due to the curative potential of the surgery, timely dissection of the inguinal nodes is vital. Although the standard of care for an inguinal lymphadenectomy has historically been an open approach, this can be plagued by morbidities such as chronic lymphedema, wound breakdown, and cellulitis. As such, minimally invasive approaches have been described to combat some of these comorbidities. In this video, we describe a robotic inguinal lymphadenectomy with the use of the SynchroSeal device, a bipolar electrosurgical instrument with fast seal activation time, that helps eliminate the need for surgical clips and reliance on an assistant.
Methods: This patient is a 75-year-old man with penile cancer who underwent a radical total penectomy and perineal urethrostomy. 4 weeks following the procedure, he underwent a robotic-assisted laparoscopic inguinal lymphadenectomy.
The surgical video begins by describing the robotic port placement for this procedure and the suggested manor to establish pneumoderma. It is important to create the space above Scarpa’s fascia while maintaining a fatty layer on the skin to avoid skin devascularization. The surgery then proceeds with creating the surgical plane and working space by marching toward the inguinal ligament. During the dissection, meticulous hemo- and lymphostasis were achieved throughout the dissection using the SynchroSeal device. The SynchroSeal works both as a dissecting tool and as a lymphatic sealer, which helps shorten the duration of the operation and also reduces the burden on the bedside assistant. This can be important, especially with a more novice assistant.
Results: Surgical pathology revealed no evidence of metastasis in 22 nodes (10 left, 12 right). The patient was discharged home on post-operative day 2.
Conclusions: This case demonstrates the feasibility of a robotic inguinal lymphadenectomy with the SynchoSeal device, which allows for adequate lymph node yields while eliminating the need for any surgical clips. Altogether, the SynchroSeal device can increase operative efficiency by serving as both a dissector and lymphatic sealer. It also allows for decreased reliance on the surgical assistant, which can be particularly beneficial in the setting of having a novice assistant.