Robotic-Assisted Inguinal Lymphadenectomy (RAIL)

Abstract

The objective of the following chapter is to describe thoroughly the surgical technique for a robotic-assisted inguinal lymphadenectomy for penile cancer, and the surgery has been through modifications from its creation to “the Robotic Era.” Penile cancer is a rare neoplasm, with an estimated 1570 cases in the United States. The spread is predictable to the inguinal lymph nodes, where 1–2% of patients will present distant metastases. The first draining lymph area is found in the inguinal region and the secondary spread in the pelvic region, main reason for the inguinal part of the treatment of penile cancer under different indications. Radical resection of inguinal metastases of penile cancer is the standard treatment for this technique, which has been adapted to become a minimally invasive surgery compared to an open inguinal lymphadenectomy, which entails a high incidence of morbidity that stands at 50–90%. A robotic-assisted inguinal lymphadenectomy, despite its high cost, is a feasible technique when carried out in specialized centers that can reduce morbidity rates and offer good oncological results, less blood loss, and shorter hospital stay.