Single-port Antegrade Robotic Lymphadenectomy: A Novel Minimally Invasive Approach to Treat Lymph Nodes in Men with Penile Cancer.

BACKGROUND AND

OBJECTIVE

Lymph node (LN) dissection (LND) improves survival in penile cancer (PenC) patients, but it is largely underused due to high morbidity associated with it. We present a novel single-port antegrade robotic lymphadenectomy (SPARL) technique to treat both inguinal and pelvic LNs through a single abdominal incision.

METHODS AND SURGICAL PROCEDURE: We included consecutive patients with T2-3 cN0-2M0 PenC who have undergone SPARL at our institution since August 2024. Using the daVinci single-port robot, through an infraumbilical incision, subcutaneous antegrade dissection allowed inguinal LND and, when indicated, pelvic LND. Perioperative surgical outcomes were assessed.

KEY FINDINGS AND LIMITATIONS: Ten patients underwent SPARL, five for staging and five for therapeutic purposes. Of them, one also received pelvic LND. No intraoperative complications or conversions to open surgery were observed. Estimated blood loss was negligible (<50 ml). The median operative time was 197 min (interquartile range [IQR]: 184-249), and the median hospital stay was 2 d (IQR: 2-3). The LN yield ranged from 12 to 16 nodes per groin. After discharge, three cases of lymphoceles and three cases of panniculitis occurred, all of which were managed conservatively.

CONCLUSIONS

SPARL is a promising technique for managing LNs in PenC, with the potential to reduce complications and accelerate recovery while ensuring an adequate nodal yield. Larger studies are needed to validate its role as a new standard of care.