V1-04: Robotic Assisted Inguinal Lymphadenectomy for Penile Cancer: The MD Anderson Cancer Center Technique
Penile squamous cell carcinoma (PSCC) is a disease that once metastasized to regional lymph nodes, leads to a dramatic reduction of survival. Inguinal lymph node dissection is the gold standard for accurate staging of the primary site of regional metastasis, however the procedure is marred by significant morbidity. Recently, robotic assisted surgery has been adapted to this procedure in the attempt to mitigate some of the complications seen in the open approach. We present our experience with this procedure at a center with a high volume of PSCC.
By rigorously adhering to the surgical templates established in the open approach, we have replicated the same procedure using robotic assisted techniques. Removing lymphatic tissue in packets helps ensure complete removal of regional lymph nodes. Using a combination of monopolar and bipolar cautery as well as hemoclips, we are able to limit the development of seromas and lymphoceles post operatively. Robotic articulation allows for the meticulous dissection of lymph node tissue over the femoral vessels in a safe and complete manner.
The RAIL procedure can reliably remove all lymphatic tissue in the inguinal region as long as attention is paid to identifying key anatomic landmarks and removing all tissue within the boundaries of the template. Adequate dissection around the femoral vessels is possible robotically and can be performed safely.
RAIL is a comparable approach for performing inguinal lymph node dissection and may offer decreased morbidity compared with open techniques. This approach is particularly well suited for the complete pathologic staging of clinically node negative patients who have high risk features.