Current Urology Reports

, 15:412 | Cite as

Early Experience of Robotic-Assisted Inguinal Lymphadenectomy: Review of Surgical Outcomes Relative to Alternative Approaches

  • Talar B. Kharadjian
  • Surena F. MatinEmail author
  • Curtis A. PettawayEmail author
Minimally Invasive Surgery (V Bird and M Desai, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Surgery


Inguinal lymph node dissection is a diagnostic and potentially curative treatment for penile carcinoma, which has historically been associated with high morbidity rates. This review summarizes the initial outcomes of robotic-assisted inguinal lymphadenectomy (RAIL) compared with the outcomes of the standard open and endoscopic approaches. The early experience suggests that RAIL may yield comparable oncologic outcomes, although future prospective studies of RAIL with greater numbers of participants and long-term follow-up are needed to evaluate the incidence and severity of perioperative and postoperative complications.


Penile cancer Inguinal lymphadenectomy Robotic surgery Morbidity Dynamic sentinel node biopsy Endoscopy Open surgery Lymph nodes Squamous cell carcinoma 


Compliance with Ethics Guidelines

Conflict of Interest

Dr. Talar B. Kharadjian, Dr. Surena F. Matin, and Dr. Curtis A. Pettaway each declare no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, et al. EAU penile cancer guidelines 2009. Eur Urol. 2010;57(6):1002–12. doi: 10.1016/j.eururo.2010.01.039. Epub 2010 Feb 4.PubMedCrossRefGoogle Scholar
  2. 2.
    Gulia AK, Mandhani A, Muruganandham K, Kapoor R, Ansari MS, Srivastava A. Impact of delay in inguinal lymph node dissection in patients with carcinoma of penis. Indian J Cancer. 2009;46(3):214–8. doi: 10.4103/0019-509X.51359.PubMedCrossRefGoogle Scholar
  3. 3.
    Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S. Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol. 2013;64(3):486–92. doi: 10.1016/j.eururo.2013.02.037. Epub 2013 Mar 6.PubMedCrossRefGoogle Scholar
  4. 4.
    D’Ancona CA, de Lucena RG, Querne FA, Martins MH, Denardi F, Netto Jr NR. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol. 2004;172(2):498–501. discussion 501.PubMedCrossRefGoogle Scholar
  5. 5.
    Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol. 2009;27(2):205–12. doi: 10.1007/s00345-008-0324-6. Epub 2008 Sep 2.PubMedCrossRefGoogle Scholar
  6. 6.
    Yao K, Tu H, Li YH, Qin ZK, Liu ZW, Zhou FJ, et al. Modified technique of radical inguinal lymphadenectomy for penile carcinoma: morbidity and outcome. J Urol. 2010;184(2):546–52. doi: 10.1016/j.juro.2010.03.140. Epub 2010 Jun 17.PubMedCrossRefGoogle Scholar
  7. 7.
    Tobias-Machado M, Tavares A, Silva MN, Molina Jr WR, Forseto PH, Juliano RV, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22(8):1687–91. doi: 10.1089/end.2007.0386.PubMedCrossRefGoogle Scholar
  8. 8.
    Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, et al. Endoscopic lymphadenectomy for penile carcinoma. J Endourol. 2007;21(4):364–7. discussion 367.PubMedCrossRefGoogle Scholar
  9. 9.
    Josephson DY, Jacobsohn KM, Link BA, Wilson TG. Robotic-assisted endoscopic inguinal lymphadenectomy. Urology. 2009;73(1):167–70. doi: 10.1016/j.urology.2008.05.060. discussion 170–1. Epub 2008 Oct 1.PubMedCrossRefGoogle Scholar
  10. 10.
    Dogra PN, Saini AK, Singh P. Robotic-assisted inguinal lymph node dissection: a preliminary report. Indian J Urol. 2011;27(3):424–7. doi: 10.4103/0970-1591.85458.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.••
    Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CP, et al. Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int. 2013;111(7):1068–74. doi: 10.1111/j.1464-410X.2012.11729.x.This is the only prospective study of RAIL to date. In addition to reporting the operative findings of RAIL, the authors provide an independent surgeon's assessment of the procedure's oncologic adequacy.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Thyavihally Y, Pednekar A, Pokharkar H. 850 da Vinci robot assisted VIDEO endoscopic inguinal lymphadenctomy (R-VEIL): initial exeperience. J Urol. 2013;189(4):349.CrossRefGoogle Scholar
  13. 13.•
    Schwentner C, Todenhöfer T, Seibold J, Alloussi SH, Mischinger J, Aufderklamm S, et al. Endoscopic inguinofemoral lymphadenectomy–extended follow-up. J Endourol. 2013;27(4):497–503. doi: 10.1089/end.2012.0489. Epub 2012 Dec 26. This retrospective study compares the differences in therapeutic outcome between endoscopic and open inguinofemoral lymphadenectomy over a mean follow-up period of 56 months for patients with penile carcinoma, melanoma, and other genitourinary malignancies. Statistical significance (calculated using chi squares and Fischer exact tests) between the two approaches was observed for operative time and complication rate.PubMedCrossRefGoogle Scholar
  14. 14.
    Leijte JA, Hughes B, Graafland NM, Kroon BK, Olmos RA, Nieweg OE, et al. Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol. 2009;27(20):3325–9. doi: 10.1200/JCO.2008.20.6870. Epub 2009 May 4.PubMedCrossRefGoogle Scholar
  15. 15.••
    Lam W, Alnajjar HM, La-Touche S, Perry M, Sharma D, Corbishley C, et al. Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. Eur Urol. 2013;63(4):657–63. doi: 10.1016/j.eururo.2012.10.035. Epub 2012 Oct 27. This prospective study analyzed the use of DSNB and ultrasound scan both with and without fine-needle aspiration cytology for clinically node-negative squamous cell penile carcinoma. DSNB sensitivity was observed to be 92%, with a false-negative rate of 5% per inguinal basin. DSNB morbidity was found to be 7.6% in this series.PubMedCrossRefGoogle Scholar
  16. 16.
    Iavazzo C, Gkegkes ID. Port site metastases after robot-assisted surgery: a systematic review. Int J Med Robot. 2013;9(4):423–7. doi: 10.1002/rcs.1512. Epub 2013 Jun 3.PubMedCrossRefGoogle Scholar
  17. 17.
    El-Tabey NA, Shoma AM. Port site metastases after robot-assisted laparoscopic radical cystectomy. Urology. 2005;66(5):1110.PubMedCrossRefGoogle Scholar
  18. 18.
    Canter DJ, Dobbs RW, Jafri SM, Herrel LA, Ogan K, Delman KA, et al. Functional, oncologic, and technical outcomes after endoscopic groin dissection for penile carcinoma. Can J Urol. 2012;19(4):6395–400.PubMedGoogle Scholar
  19. 19.
    Pahwa HS, Misra S, Kumar A, Kumar V, Agarwal A, Srivastava R. Video Endoscopic Inguinal Lymphadenectomy (VEIL)–a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma. World J Surg Oncol. 2013;11:42. doi: 10.1186/1477-7819-11-42.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Zhou XL, Zhang JF, Zhang JF, Zhou SJ, Yuan XQ. Endoscopic inguinal lymphadenectomy for penile carcinoma and genital malignancy: a preliminary report. J Endourol. 2013;27(5):657–61. doi: 10.1089/end.2012.0437. Epub 2013 Mar 7.PubMedCrossRefGoogle Scholar
  21. 21.
    Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications, and late utcomes– evaluation of 340 procedures. J Urol. 2013;190(6):2086–92. doi: 10.1016/j.juro.2013.06.016. Epub 2013 Jun 11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations