Minimally invasive approaches to the inguinal nodes in cN0 patients

In penile cancer, lymphadenectomy can have staging and possibly therapeutic values. However, many physicians and patients are reluctant when it comes to inguinal lymph node dissection (ILND) due to high rate of surgical morbidities. In recent years, minimally invasive surgical approaches have shown success in reducing perioperative morbidities.

Newer surgical modalities, including videoscopic inguinal lymphadenectomy and robotic-assisted inguinal lymphadenectomy, have been explored to reduce the morbidities of ILND while not compromising oncologic outcomes. Data on this topic is limited but available data suggest that these minimally invasive techniques are safe and associated with less perioperative morbidities. There is no study to directly compare the oncological outcome between these different techniques. However, number of dissected lymph nodes is used a surrogate for oncologic outcomes. Different treatment approaches including open, laparoscopic, and robotic seem to be similar and effective in terms of nodal yield.

Laparoscopic and robotic approaches are successful in dissecting inguinal lymph nodes and are associated with lower rate of major perioperative complications. Individual patient's characteristics as well as surgeon's experience should be considered when trying to decide the optimum surgical modality for ILND.