Initial experience and technical description of robot-assisted single-port laparoscopic bilateral inguinal lymph node...

Penile cancer is a rare malignancy of the urogenital system with a well-defined lymphatic metastatic pathway. Inguinal lymph node dissection remains the cornerstone for managing lymph node metastasis in penile cancer and can effectively control disease spread. However, conventional open surgery is associated with a high rate of complications, including skin necrosis, infection, and lymphedema, and the substantial surgical trauma limits its widespread clinical use. To reduce invasiveness, we introduce a novel surgical approach designed to enhance dissection accuracy and completeness. This study aims to evaluate the feasibility and safety of robot-assisted single-port laparoscopic bilateral inguinal and pelvic lymph node dissection via a suprapubic antegrade approach.

We report two cases of penile squamous cell carcinoma treated with this technique. Case 1 was a 61-year-old male presented with a progressively enlarging penile mass with superficial ulceration. Histopathology revealed moderately differentiated squamous cell carcinoma [non-human papillomavirus (HPV)-associated] with lymph node metastasis. The patient first underwent radical penectomy, followed by robot-assisted single-port laparoscopic bilateral inguinal and pelvic lymph node dissection two weeks later. Case 2 was a 53-year-old male presented with penile pain. Preoperative imaging revealed a malignant lesion on the glans penis accompanied by bilateral inguinal lymphadenopathy. The patient underwent immediate radical penectomy combined with robot-assisted single-port laparoscopic bilateral inguinal lymph node dissection. Both patients recovered without major postoperative complications. During follow-up (case 1: 6 months; case 2: 2 months), neither experienced tumor recurrence nor significant adverse events.

Our preliminary experience indicates that robot-assisted single-port laparoscopic bilateral inguinal lymph node dissection is technically feasible in this small case series. The technique offers favorable cosmetic outcomes due to the single concealed incision. However, long-term oncologic outcomes require further investigation, and additional studies with larger cohorts and extended follow-up are needed to confirm its clinical effectiveness.