AB180. SOH26AB_0170. Two case reports of implementation of robotic pelvic lymphadenectomy in penile cancer: early experience from a national referral centre

Background: Pelvic lymphadenectomy is indicated in selected cases of penile cancer with radiologically or pathologically confirmed advanced nodal disease. Traditionally performed using an open approach, pelvic lymph node dissection is associated with considerable morbidity. The introduction of robotic-assisted techniques offers enhanced visualization, precision, and potentially reduced postoperative complications. Since the centralization of penile cancer services in 2021, Beaumont Hospital has managed approximately 80 new cases annually. This report describes the first robotic pelvic lymphadenectomy procedures performed for metastatic penile cancer in Beaumont Hospital.

Case Description: Two patients with ¹⁸F-fluorodeoxyglucose (FDG) avid pelvic nodal metastases on positron emission tomography-computed tomography (PET-CT) underwent robotic pelvic lymphadenectomy via a transperitoneal approach using predefined lymphatic templates. Surgical technique, perioperative course, complications, and pathological outcomes were reviewed. Nodal packets were retrieved en bloc to maintain oncological integrity. The first patient with pT3N3 (tumour invading the corpora cavernosa/urethra with pelvic nodal metastasis or extranodal extension) disease following radical penectomy and bilateral inguinal lymphadenectomy underwent bilateral robotic pelvic lymphadenectomy. The second patient with recurrent nodal disease following pT1b (subepithelial invasion with high-risk features) penile cancer underwent unilateral robotic dissection. Both procedures were completed robotically without conversion or intraoperative complications. The robotic platform facilitated improved anatomical exposure, stable instrument control, and precise vascular dissection in previously operated fields. Postoperative recovery was uncomplicated, and both patients proceeded to adjuvant chemoradiotherapy without delay. Histopathology confirmed metastatic pelvic involvement in both cases, including extracapsular extension in one.

Conclusions: Early experience demonstrates that robotic pelvic lymphadenectomy is a feasible, safe, and technically advantageous option for selected patients with metastatic penile cancer. Further evaluation in larger cohorts with long-term oncological follow-up is warranted.

Keywords: Penile cancer; pelvic lymphadenectomy; robotic surgery; surgical oncology; case report