Introduction: High risk penile cancer following penectomy is often treated with inguinal lymph node dissection. Classically, inguinal lymph node dissections were performed by opening both inguinal regions, with risk of wound complications including skin break down, flap necrosis, and lymphatic complications such as lymphedema or lymphoceles. With the popularization of the single-port robotic system, novel surgeries have taken advantage of its ability to work in tight spaces. Here, bilateral inguinal lymph node dissection is performed through a single suprapubic incision using the single-port robot. The goals are to minimize wound complications associated with open inguinal lymph node dissections while maintaining safety and oncologic outcomes.
Methods: An 82-year-old male with T3 penile squamous cell carcinoma 4 months after recovery from a total penectomy with perineal urethrostomy was offered a single-port robotic antegrade bilateral inguinal lymph node dissection. The SP port was placed midline over the suprapubic region into the Space of Retzius similar to that of an extraperitoneal SP radical prostatectomy. Bilateral external iliac vessels were isolated and the spermatic cord was followed along its lateral edge distally until the inguinal ligament was seen. The external oblique aponeurosis was split anterior to the inguinal ligament, revealing the superficial compartment, where lymph nodes packets were retrieved. The deep compartment was then accessed by dissecting through fascia lata posteriorly and skeletonizing the femoral vessels. After completion of the deep inguinal lymph node dissection, bilateral 15 French drains were placed into both surgical sites. The abdominal wall fascial incision was closed with interrupted figure-of-8 absorbable sutures.
Results: Operative time was 3 hours and 16 minutes, with estimated blood loss 20 mL. The patient was discharged to home on post-op day 1 with both drains, which were then removed in 2 weeks. There was a total nodal yield of 15, all of which were negative for metastatic disease. There were no 30-day complications for this patient.
Conclusions: An antegrade approach through a single suprapubic incision using the single-port robot gives excellent access to bilateral inguinal spaces that would be otherwise difficult with a multi-port robot. Larger case series should be performed, but its potential advantages include lower risk of wound complications, decreased risk of lymphatic complications, and access to pelvic lymph node dissection when appropriate.
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