Initial experience and technical description of robot-assisted single-port laparoscopic bilateral inguinal lymph node dissection for penile cancer: a report of two cases

Introduction

Penile cancer (PenC) is a rare malignancy of the urogenital system, accounting for less than 1% of all newly diagnosed male cancers worldwide each year (1). Approximately 95% of PenCs are penile squamous cell carcinomas (PSCCs), which exhibit a well-characterized pattern of lymphatic spread (2). Management of inguinal lymph nodes is fundamental to the treatment of PenC (3). Inguinal lymph node dissection (ILND) represents the most reliable surgical staging procedure, removing lymph nodes in the inguinal region following penectomy to eradicate potential metastatic disease and prevent further dissemination (4).

However, conventional ILND is associated with a high complication rate, reaching up to 25%, including skin necrosis, wound infection, lymphedema, seroma, lymphocele formation, and deep vein thrombosis (5,6). To reduce surgical morbidity, several modifications and minimally invasive approaches, such as video-endoscopic inguinal lymph node dissection (VEIL) and robot-assisted inguinal lymph node dissection (RAIL), have been developed (7-10). A randomized controlled trial demonstrated that endoscopic ILND significantly decreases complication rates (20% vs. 70%; P<0.001) without compromising oncological outcomes (11).

Previous minimally invasive approaches largely relied on retrograde pathways (12), which are associated with multiple incisions and loss of the operative triangle. The emergence of laparoendoscopic single-site surgery (LESS), and particularly the next-generation robot-assisted single-port laparoscopy (R-LESS) using the da Vinci Xi system, offers advantages in minimizing invasiveness while maintaining favorable cosmetic outcomes (2).

Although prior reports have described ILND using single-port robotic systems via lateral or retrograde approaches (12,13), these techniques require additional incisions and trocars, increasing both patient cost and surgical trauma. In contrast, a single suprapubic incision following an antegrade anatomical pathway allows simultaneous dissection of bilateral lymph nodes. This approach uses the inguinal ligament, the spermatic cord, and the femoral vessels as key landmarks, potentially enhancing both surgical precision and the completeness of lymph node clearance (14).

The present study aims to preliminarily assess the feasibility and safety of bilateral inguinal lymph node dissection (BILND) and pelvic lymph node dissection via the suprapubic R-LESS technique, with the goal of providing a more optimized surgical strategy for patients with PenC. We present this case in accordance with the CARE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0373/rc).

Case presentation

Patient information and presentation

Two patients were included in this study. Case 1 was a 61-year-old male presented with a progressively enlarging penile mass with superficial ulceration for over one year. Based on clinical history, histopathological findings, and imaging studies, case 1 was diagnosed with moderately differentiated PSCC [non-human papillomavirus (HPV)-associated], clinically staged as cT_1bN₃M₀. Case 2 was a 53-year-old male presented with penile pain persisting for over two months. Following circumcision at an outside hospital, a glans mass was identified and preoperative imaging suggested cT₁N_1–2M₀ disease. Perioperative data were prospectively collected, and surgical outcomes are summarized in Table 1. All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of The Third Affiliated Hospital of Southern Medical University (No. N202510-08). Written informed consent was obtained from the patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Preoperative preparation

Both patients underwent comprehensive preoperative assessment. In case 1, preoperative positron emission tomography-computed tomography (PET-CT) demonstrated increased uptake of the glucose-based radiotracer in the inguinal and pelvic regions (red arrows on fused images), indicating metabolically active metastatic lesions, with a urinary catheter (Foley catheter) visible from prior penile biopsy (Figure 1). The patient underwent radical penectomy with perineal urethrostomy on May 15, 2025. Postoperative recovery was uneventful, and two weeks later, he underwent robot-assisted single-port laparoscopic bilateral inguinal and pelvic lymph node dissection. In case 2, preoperative pelvic magnetic resonance imaging (MRI) and whole-abdominal computed tomography angiography (CTA) revealed a malignant glans lesion with bilateral inguinal lymphadenopathy. Clinical suspicion of metastasis prompted immediate radical penectomy combined with robot-assisted single-port laparoscopic BILND on January 19, 2026. Both patients received standard perioperative preparation and were fully informed of all available treatment options, as well as the potential risks and complications associated with the procedures.

Figure 1 PET-CT scan of case 1. Utilizing a glucose-based tracer, the fused images (upper right and lower left) highlight metastatic lesions (red arrows) due to increased tumor metabolism. A urinary catheter (Foley catheter) is visible, placed following prior penile biopsy. PET-CT, positron emission tomography-computed tomography.

Surgical technique

Patient positioning

The da Vinci Xi system was used with arms No. 2–4, with arm No. 3 serving as the camera arm. A Kangji four-channel single-site port (4×8-mm trocars) was inserted. Under general anesthesia, both patients were placed in the supine position with shoulder supports and 30° Trendelenburg tilt.

Lymph node dissection of superficial and deep inguinal region

Using the separation plane between the shallow and deep layers of campers, first clean the deep inguinal lymph nodes, then clean the shallow inguinal lymph nodes, while preserving the fascia lata during this process. Subsequently, the fascial adipose tissue on the surface of the great saphenous vein was cut open, and then the superficial inguinal lymphoid adipose tissue was freed on the surface of the fascia lata. Remove the cleaned lymph nodes after complete dissociation. The specific cleaning range is from the inner side to the pubic tubercle near the spermatic cord, and from the outer side to the anterior superior iliac level. Afterwards, open the femoral artery sheath, clean the deep inguinal lymph nodes, and ligate the deep inguinal lymph vessels. During the surgical process, the main stem of the great saphenous vein is released and preserved, whereas the branches of the great saphenous vein are clamped. Similarly, treat the right inguinal lymph nodes using the same approach. The key steps of inguinal lymph node dissection are shown in Figure 2.

Figure 2 Intraoperative procedural details. (A) The primary surgeon performing the robot-assisted procedure. (B,C) Placement of the single-port access device and docking of the robotic system. (D) The dissection plane is established between the superficial and deep layers of Camper’s fascia, revealing the femoral triangle, inguinal ligament, the sartorius muscle laterally, the femoral artery and vein medially, and the superficial inguinal lymph nodes superiority. (E) Identification of the left femoral arterial sheath. The fascia lata is preserved while dissecting the left superficial inguinal lymph nodes. (F) Ongoing dissection of the left superficial inguinal lymph nodes. (G) The fascia and adipose/lymphatic tissue overlying the left GSV are incised and the main trunk of the GSV and its tributaries are preserved; the deep inguinal lymph nodes along the vessels are dissected, followed by systematic en bloc resection of the superficial inguinal lympho-adipose tissue from the pubic tubercle (near the spermatic cord) to the level of the anterior superior iliac spine. (H) The right inguinal ligament is identified as a key anatomical landmark for dissecting the deep inguinal lymph nodes adjacent to the femoral artery and vein. (I) Dissection of the right superficial inguinal lymph nodes. (J) The main trunk of the right GSV is preserved to expose deeper structures. Its distal branches are clipped, and the surrounding lymph nodes are completely resected. GSV, great saphenous vein.

Pelvic lymph node dissection

After removing the single port kit, we attached the single port laparoscopic kit, placed the robotic arm, and proceeded to open the peritoneum into the pelvic cavity: open the parietal peritoneum and release the external iliac arteries close to the common iliac artery’s bifurcation along the inner ring opening after first exploring and exposing the bilateral external iliac arteries; send the free lymph nodes and adipose tissue around the iliac artery for pathological study. After the surgery, one pelvic drainage tube was put in the auxiliary orifice, and one drainage tube was implanted above both inguinal areas. Intraoperative photographs of the pelvic lymphadenectomy—including peritoneal entry, identification of the external iliac vessels, and nodal dissection around the iliac bifurcation—are provided in Figure 3.

Figure 3 Pelvic lymph node dissection through the suprapubic single-port approach. (A) Opening of the parietal peritoneum to enter the pelvic cavity. (B) Identification and exposure of the right external iliac vein. (C) Dissection of pelvic lymph nodes at the bifurcation of the right external iliac artery and vein; the specimen is shown en bloc with the surrounding adipose tissue. (D) Dissection of pelvic lymph nodes along the left external iliac artery and vein, with the nodal packet mobilized for retrieval.

Results

Case 1 underwent robot-assisted surgery using a single-port laparoscopic approach for bilateral inguinal and pelvic lymph node dissection. In case 2, the surgical procedure followed the same antegrade approach. However, the patient’s preoperative cN_1–2 staging and intraoperative frozen section findings, which confirmed PSCC with negative surgical margins, precluded prophylactic pelvic lymph node dissection. Consequently, the procedure was limited to BILND. Postoperative photographs of both patients are shown in Figure 4, and a summary of surgical outcomes is presented in Table 2. Intraoperative blood loss for case 1 was 150 mL, with no transfusion required. The drainage tube was removed on postoperative day 22. The patient’s total hospital stay of 71 days comprised three distinct phases: (I) preoperative evaluation and radical penectomy (19 days), (II) interval recovery before lymphadenectomy (14 days), and (III) post-lymphadenectomy inpatient observation (36 days). The subsequent four cycles of adjuvant TIP chemotherapy were delivered during separate scheduled readmissions and are not included in this 71-day count. In case 2, intraoperative blood loss was 50 mL, and the drainage tube was removed on postoperative day 16, with a total hospital stay of 22 days. During follow-up and subsequent examinations, neither patient demonstrated evidence of local tumor recurrence or distant metastasis. These figures reflect our early experience with this technically demanding procedure and should be interpreted as initial learning-curve observations rather than benchmarks of surgical efficiency.

Figure 4 Postoperative image of (A) case 1 and (B) case 2.

Discussion

The incidence of PenC varies geographically, while because of large population in China, the absolute number of cases remains considerable (15). Inguinal lymph node dissection (ILND) remains a cornerstone for the management of lymphatic metastasis in PenC, yet it is associated with a high complication rate (4). Minimally invasive techniques, such as video-endoscopic inguinal lymphadenectomy (VEIL) and robot-assisted inguinal lymph node dissection (RAIL), have been developed to reduce surgical trauma and lower complication rates (16-18). This study reports preliminary experience with BILND using a robot-assisted single-port laparoscopic (R-LESS) approach via a suprapubic antegrade route in two patients. Case 1, staged as cN₃, underwent concurrent pelvic lymph node dissection, whereas case 2, staged as cN_1–2, underwent inguinal lymph node dissection alone. Neither patient experienced severe postoperative complications, and short-term follow-up demonstrated no evidence of recurrence, providing preliminary support for the safety and feasibility of this technique across different tumor burdens.

In case 1, the drainage tube was retained for 22 days following robotic single-port laparoscopic inguinal lymph node dissection. Prolonged drainage times have also been observed in other robotic ILND series. Ozambela et al. reported a median drain duration of 37 days in their robotic cohort versus 22 days for open surgery in clinically node-negative PenC patients (19). A randomized trial in melanoma patients demonstrated that complete drain removal at 3 weeks was non-inferior to progressive removal (20). Furthermore, a large retrospective study of PenC patients identified diabetes as a significant risk factor for wound complications and poor wound healing following ILND (21). Given case 1’s multiple comorbidities including type 2 diabetes, the 22-day drainage duration in our series is clinically justified and within the reported range. In case 2, the drainage tube was removed on postoperative day 16, which also falls within the ranges observed in the literature.

In case 2, although preoperative imaging suggested cN_1–2 disease, final pathology revealed no nodal metastasis (0/27 left, 0/12 right)—an important example of radiological overstaging. We acknowledge that dynamic sentinel lymph node biopsy (DSNB) is preferred for cN₀ patients per European Association of Urology-American Society of Clinical Oncology Clinical Practice (EAU-ASCO) guidelines (4); however, it is not indicated for cN₊ disease, for which radical ILND remains the standard. Case 2 had imaging evidence of bilateral inguinal lymphadenopathy (cN₊) and thus underwent radical ILND per guidelines. The pN₀ result highlights that imaging may overstage nodal disease, suggesting that future studies might explore neoadjuvant treatment or more selective strategies in similar scenarios.

Traditional single port laparoscopic surgery causes confusion in the left and right orientation of the surgeon due to cross operation of instruments, and requires continuous concentration to avoid collisions, which significantly increases cognitive load (22). In contrast, robotic systems provide a three-dimensional magnified view, enhanced dexterity, and stable instrument control, which are advantageous in the limited prepubic operative space (23). In this study, the da Vinci Xi system which was widely used in China, was employed rather than the da Vinci SP system. The procedure was performed via a subumbilical incision, which reduces the required robotic arm length compared with a standard umbilical incision. Although there are no direct comparisons of da Vinci SP and Xi systems in inguinal lymph node dissection, and direct comparative data between SP and multi-port systems are still lacking, studies in other urological procedures (such as radical prostatectomy and adrenalectomy) and research by Pandolfo et al. indicate comparable functional outcomes, oncological efficacy, and positive margin rates, suggesting that single-port approaches may further reduce wound complications in ILND (24,25).

Furthermore, the suprapubic antegrade single-port approach optimizes surgical planes, minimizes vascular injury and ensures thorough lymph node removal. For patients with relative contraindications like case 1 with diabetes, the avoidance of long bilateral incisions theoretically reduces the risk of wound infection, dehiscence, and delayed healing (2). Although delayed wound healing occurred in this patient due to comorbidities, no adverse events such as wound rupture were observed, confirming the potential advantages of this approach. Additionally, the suprapubic incision traverses thicker subcutaneous tissue compared with direct groin incisions, which may reduce the risk of postoperative skin necrosis—an important consideration in patients with diabetes and other wound-healing risk factors.

Currently, some concerns have been raised regarding the oncological thoroughness of endoscopic lymphadenectomy, with some reports suggesting fewer lymph nodes are harvested compared with open surgery (26). In this series, 29 inguinal lymph nodes were harvested in case 1 and 39 in case 2, achieving satisfactory lymph node counts and addressing these concerns. Early lymph node dissection in clinically occult metastases has been shown to improve prognosis (27). While surgery alone rarely cures patients with cN₃ disease, this approach reduces complication rates while maintaining curative intent, allowing patients to proceed with adjuvant therapy as indicated (28,29). In case 1 (cT_1bN₃M₀ with resectable, non-fixed inguinal nodes), upfront surgery was chosen after multidisciplinary discussion. Per the EAU-ASCO 2023 guidelines (4), neoadjuvant chemotherapy is primarily indicated for unresectable (fixed/ulcerated) cN3 disease, whereas upfront radical ILND followed by adjuvant chemotherapy for pN3 remains a standard treatment pathway. The patient subsequently completed four cycles of adjuvant TIP chemotherapy.

However, evidence supporting prophylactic pelvic lymph node dissection (pPLND) without radiologic or clinical indications remains limited (4). Some studies indicate that pelvic nodal positivity correlates with the number of positive inguinal nodes, with higher positivity rates observed in patients with three or more positive nodes (30,31). Recent guideline comparisons have confirmed that ≥3 positive inguinal nodes or extracapsular extension are the strongest predictors of pelvic involvement, supporting selective pPLND in such patients (32). In case 1, preoperative imaging suggested pelvic metastasis, and pathological examination confirmed involvement (5/13 nodes), supporting selective pPLND. Case 2 did not undergo pPLND, consistent with guideline-based individualized treatment.

Definitely, limitations of this study include the small sample size and the technical complexity of robotic single-port surgery, which may prevent widespread adoption and prolong operative times during the learning curve. Meanwhile, due to the rarity of PenC and the absence of direct comparisons with open or multi-port laparoscopic approaches, quantitative assessment of postoperative pain, recovery quality, and cost-effectiveness was difficult and longer follow-up is required to assess long-term oncological outcomes. These limitations are consistent with the experience reported by Perdonà et al. (33) and are inherent to the learning curve of this novel single-port approach. Therefore, standardized training and multicenter collaboration are essential to enhance safety and reproducibility.

Overall, the suprapubic R-LESS approach for BILND appears technically feasible in this preliminary experience. It offers a single concealed incision with favorable cosmetic outcomes, providing a potential minimally invasive option for carefully selected patients with PenC. Further comparative studies are needed to evaluate its safety and efficacy relative to open surgery.

Conclusions

Robot-assisted single-port laparoscopic surgery appears technically feasible for inguinal lymph node dissection in PenC in this preliminary two-case series. However, prospective studies with larger sample sizes and extended follow-up are necessary to fully evaluate its oncological efficacy and safety.

Acknowledgments

The authors thank the two patients for their trust and cooperation.

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0373/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0373/prf

Funding: This work was supported by the President Foundation of The Third Affiliated Hospital of Southern Medical University (Nos. YM202504 and YL202201).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0373/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of The Third Affiliated Hospital of Southern Medical University (No. N202510-08). Written informed consent was obtained from the patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Montes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica 2017;41:e117. [Crossref] [PubMed]
2. Thomas A, Necchi A, Muneer A, et al. Penile cancer. Nat Rev Dis Primers 2021;7:11. [Crossref] [PubMed]
3. Hu J, Cui Y, Liu P, et al. Predictors of inguinal lymph node metastasis in penile cancer patients: a meta-analysis of retrospective studies. Cancer Manag Res 2019;11:6425-41. [Crossref] [PubMed]
4. Brouwer OR, Albersen M, Parnham A, et al. European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. Eur Urol 2023;83:548-60. [Crossref] [PubMed]
5. Patel KN, Salunke A, Bakshi G, et al. Robotic-Assisted Video-Endoscopic Inguinal Lymphadenectomy (RAVEIL) and Video-Endoscopic Inguinal Lymphadenectomy (VEIL) versus Open Inguinal Lymph-Node Dissection (OILND) in carcinoma of penis: Comparison of perioperative outcomes, complications and oncological outcomes. A systematic review and meta-analysis. Urol Oncol 2022;40:112.e11-22. [Crossref] [PubMed]
6. Cacciamani GE, Medina LG, Sayegh AS, et al. Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis. World J Surg 2023;47:962-74. [Crossref] [PubMed]
7. d'Ancona CA, de Lucena RG, Querne FA, et al. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol 2004;172:498-501; discussion 501. [Crossref] [PubMed]
8. Thyavihally YB, Dev P, Waigankar SS, et al. Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis. J Robot Surg 2021;15:905-14. [Crossref] [PubMed]
9. Tobias-Machado M, Tavares A, Ornellas AA, et al. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 2007;177:953-7; discussion 958. [Crossref] [PubMed]
10. Sotelo R, Sánchez-Salas R, Carmona O, et al. Endoscopic lymphadenectomy for penile carcinoma. J Endourol 2007;21:364-7; discussion 367. [Crossref] [PubMed]
11. Tobias-Machado M, Tavares A, Silva MN, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol 2008;22:1687-91. [Crossref] [PubMed]
12. Elsamra SE, Poch MA. Robotic inguinal lymphadenectomy for penile cancer: the why, how, and what. Transl Androl Urol 2017;6:826-32. [Crossref] [PubMed]
13. Jindal T, Meena M. Laparoscopic and robotic video endoscopic inguinal lymphadenectomy by the lateral approach. Asian J Endosc Surg 2021;14:464-9. [Crossref] [PubMed]
14. Sun D, Zhang H, Diao T, et al. Comparison of antegrade and retrograde laparoscopic bilateral inguinal lymphadenectomy for penile cancer. J Cancer Res Ther 2024;20:2061-5. [Crossref] [PubMed]
15. Pang C, Guan Y, Li H, et al. Urologic cancer in China. Jpn J Clin Oncol 2016;46:497-501. [Crossref] [PubMed]
16. Singh A, Jaipuria J, Goel A, et al. Comparing Outcomes of Robotic and Open Inguinal Lymph Node Dissection in Patients with Carcinoma of the Penis. J Urol 2018;199:1518-25. [Crossref] [PubMed]
17. Gkegkes ID, Minis EE, Iavazzo C. Robotic-assisted inguinal lymphadenectomy: a systematic review. J Robot Surg 2019;13:1-8. [Crossref] [PubMed]
18. Kharadjian TB, Matin SF, Pettaway CA. Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches. Curr Urol Rep 2014;15:412. [Crossref] [PubMed]
19. Ozambela M Jr, McCormick BZ, Rudzinski JK, et al. Robotic or open superficial inguinal lymph node dissection as staging procedures for clinically node negative high risk penile cancer. Urol Oncol 2024;42:120.e1-9. [Crossref] [PubMed]
20. Frich L, Hermann R, Berentzen Å, et al. Randomized Study of Wound Drainage on Early Complications After Lymph Node Dissection for Melanoma. J Surg Res 2021;267:467-76. [Crossref] [PubMed]
21. Gao Y, Shao Y, Hu X, et al. Risk factors for postoperative surgical complications after inguinal lymph node dissection in penile cancer patients. Sci Rep 2025;15:9618. [Crossref] [PubMed]
22. Tang B, Hou S, Cuschieri SA. Ergonomics of and technologies for single-port lapaxroscopic surgery. Minim Invasive Ther Allied Technol 2012;21:46-54. [Crossref] [PubMed]
23. Dell'Oglio P, Palagonia E, Wisz P, et al. Robot-assisted Boari flap and psoas hitch ureteric reimplantation: technique insight and outcomes of a case series with ≥1 year of follow-up. BJU Int 2021;128:625-33. [Crossref] [PubMed]
24. Bao EH, Hao P, Li JW. Comparison of da Vinci SP and Xi surgical systems in urologic surgery: a systematic review and meta-analysis. J Robot Surg 2025;20:8. [Crossref] [PubMed]
25. Pandolfo SD, Biasatti A, Parnham A, et al. Current Role of Robotic Inguinal Lymphadenectomy in Penile Cancer. Eur Urol Focus 2025;11:43-5. [Crossref] [PubMed]
26. Hu J, Li H, Cui Y, et al. Comparison of clinical feasibility and oncological outcomes between video endoscopic and open inguinal lymphadenectomy for penile cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2019;98:e15862. [Crossref] [PubMed]
27. Kroon BK, Horenblas S, Lont AP, et al. Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 2005;173:816-9. [Crossref] [PubMed]
28. Alnajjar HM, MacAskill F, Christodoulidou M, et al. Long-term outcomes for penile cancer patients presenting with advanced N3 disease requiring a myocutaneous flap reconstruction or primary closure-a retrospective single centre study. Transl Androl Urol 2019;8:S13-21. [Crossref] [PubMed]
29. Koifman L, Hampl D, Ginsberg M, et al. The role of primary inguinal surgical debulking for locally advanced penile cancer followed by reconstruction with myocutaneous flap. Int Braz J Urol 2021;47:1162-75. [Crossref] [PubMed]
30. Lont AP, Kroon BK, Gallee MP, et al. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol 2007;177:947-52; discussion 952. [Crossref] [PubMed]
31. Liu JY, Li YH, Zhang ZL, et al. The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection. World J Urol 2013;31:1519-24. [Crossref] [PubMed]
32. Aveta A, Iossa V, Spena G, et al. Penile cancer and lymph node management: a call for standardization. Int Urol Nephrol 2026;58:1571-8. [Crossref] [PubMed]
33. Perdonà S, Izzo A, Tufano A, et al. Advancing Surgical Management of Penile Cancer: Single Port Bilateral Inguinal Lymph Node Dissection. Int Braz J Urol 2025;51:e20240663. [Crossref] [PubMed]