Current Role of Robotic Inguinal Lymphadenectomy in Penile Cancer

Lymph node (LN) metastases are the most significant prognostic factor in penile cancer (PeC), so timely detection and adequate treatment of LN metastases is crucial. While open inguinal LN dissection (ILND) remains the standard for most cases, its morbidity has spurred interest in robot-assisted videoendoscopic ILND (RA-VEIL). We summarize current international guidelines and evidence on the current role of RA-VEIL in LN management for PeC. RA-VEIL is feasible and has been associated with fewer wound complications and an equivalent nodal yield in comparison to open ILND. However, lymphatic complications appear to remain the same. Therefore, for nodal staging in patients with cN0 PeC, sentinel node biopsy is preferred over RA-VEIL. In node-positive patients, more studies, especially prospective studies, are needed to confirm the long-term oncological safety of RA-VEIL before it can be incorporated in guidelines as a recommended treatment option. PATIENT SUMMARY: For patients with penile cancer, spread to the lymph nodes is a crucial factor in determining probable survival. We summarize the current role of a robot-assisted telescopic technique under video guidance for lymph node management. This technique is feasible and may lead to fewer wound infections, but lymphatic complications seem to be the same as with open surgery. More studies are needed to confirm the long-term cancer control outcomes of this technique.