To discuss the surgical strategy and clinical effects of robotic assisted laparoscopic antegrade inguinal lymphadenectomy for penile cancer.

We retrospectively analyzed the clinical data and surgical strategy on the 7 cases, who undergoing robotic assisted laparoscopic antegrade inguinal lymphadenectomy, from August of 2016 to August of 2017. The mean age of 7 patients was (49.7±7.5) years old, ranged from 40 to 62 years old, the mean BMI was (27.97±3.86) kg/m², ranged from 21.76 to 33.21 kg/m². There were 4 cases of T₁, 2 cases of T₂, 1 case of T₃, 1 case of N₁, 3 cases of N₂, 3 cases of N₃ according to TNM stages. Preoperative preparation was as follows, preoperative cardiopulmonary assessment, inguinal and pelvic CT or MRI, ultrasound of lower extremity venous, bowel preparation. The patients were placed in a supine position, with an indwelling catheter, with the head positioned lower than the hip at an angle of about 15 degrees, legs were spread apart around 45 degrees, and both knees were slightly bent and externally rotated. The da Vinci robotic patient cart was pushed forward between legs of the patient. A blunt separation was carried out between Scarpa's fascia and the surface of the aponeurosis of the obliquus externus abdominis prior, then subcutaneous space was established by a self-made balloon dilatation.

7 cases were completed successfully without robot reposition without any conversion. Operative time of each side ranged from 50 to 90 min(70.0±12.5)min. The blood loss of each side was less than 10 ml. In the 7 cases, the number of nodes removed from left inguinal region ranged from 7 to 18 (14.0±3.3). The number of nodes removed from right ranged from 5 to 21 (11.0±3.3). Pelvic lymphadenectomy was completed in the meantime by original trocar site on 4 cases. Till now, no perioperative complications, such as flap necrosis, delayed healing of incision, cellulitis, occurred in inguinal region, except lymphorrhagia in 3 cases. During a follow-up within 3-14 months, there was no recurrence or metastasis in 6 cases except one died from tumor progression with systemic metastasis.

Antegrade inguinal lymphadenectomy for penile cancer by using Da Vinci robotic surgical system is safe and effective. This technique also appears to diminish the wound related complications associate with the standard open approach. Compared with the similar surgery, we conducted bilateral inguinal lymphadenectomy without patient cart reposition, which simplify the procedure and reduce the using of trocar. According to individual clinical conditions, pelvic lymphadenectomy also can be completed in the meantime by original trocar.

Robotic surgery; Penile cancer; Inguinal lymphadenectomy