Introduction: Inguinal lymphadenectomy (ILND) is the standard of care for patients with invasive squamous cell carcinoma (SCC) of the penis but it is still often omitted due to the morbidity associated with open surgery. To help mitigate wound-related complications, a minimally invasive (MI) approach was proposed in 2003 but its spread was probably hampered by the lack of confindence of the urologists with the endoscopic anatomy of the groin.
Methods: we describe the pivotal points of surgical anatomy of the groin and present our technique for a robot-assisted approach to radical ILND. We also report outcomes of our multicenter database on ILND for penile cancer.
Results: overall, 257 patients were included in the study and 233 required an ILND, which was performed with a MI approach in 22 cases. Among these, 6 (27%) were robot-assisted.A partial or radical penectomy was also performed in 7 (32%) and 3 (14%) cases, respectively. Median operation time was 300 min (IQR: 285-325), mainly for ILND (225 min; IQR: 200-240). One single intraoperative complication was recorded, which required conversion to open surgery. Median length of stay was 6 days and inguinal drains were removed on post-operative day 29 (IQR: 22-36). Major post-operative complications were observed in 4 patients (18%).
Conclusions: the surgical anatomy of the groin learnt in open surgery is useful when a minimally invasive approach is preferred. Video-endoscopic ILND is safe and effective, though dramatically underutilized also in referral centers.