Surgery in Motion: Different Surgical Techniques for Inguinal Lymph Node Dissection in Penile Cancer

Inguinal lymph node dissection (ILND) remains a cornerstone of nodal management in penile cancer, providing definitive treatment for clinically node-positive disease and surgical staging for high-risk clinically node-negative patients when dynamic sentinel node biopsy (DSNB) is unavailable. Despite its oncological importance, ILND is associated with substantial morbidity. Over the past decade, minimally invasive (MI) approaches have emerged as alternatives to open ILND, with the potential to reduce wound-related complications while maintaining oncological efficacy. This Surgery in Motion article provides a practical overview of contemporary open, video-endoscopic (VEIL), and robot-assisted (RAVEIL) ILND techniques, integrating anatomical principles, technical variations, and current clinical evidence. Open ILND remains the reference approach, particularly in patients with advanced nodal disease, while MI techniques may be considered in selected patients with limited nodal disease at experienced centres. Across all approaches, meticulous adherence to anatomical templates, appropriate patient selection, and preservation of lymphatic and vascular structures where oncologically feasible are key principles for minimising morbidity. Emerging robotic and image-guided technologies may further refine ILND, although their clinical benefits and long-term oncological outcomes require further evaluation. This stepwise educational review and accompanying surgical video aim to support surgical training, standardisation, and safe implementation of contemporary ILND techniques.