單孔機器人手臂輔助雙側髂腹股溝淋巴結清除術合併ICG螢光導引：於晚期陰莖鱗狀細胞癌之創新應用

王信惠、陳柏諺、蔡牧堯

高雄長庚紀念醫院 外科部 泌尿科

Single-Port Robotic-Assisted Bilateral Ilio-Inguinal Lymphadenectomy with Indocyanine Green (ICG) Guidance: A Novel Approach for Advanced Penile Squamous Cell Carcinoma

Shing-Hui Wang, Po-Yen Chen, Mu-Yao Tsai

Department of Urology, Kaohsiung Chang Gung Memorial Hospital

Background:
Inguinal lymph node dissection (ILND) is essential in the management of penile cancer but is associated with significant morbidity. Minimally invasive approaches, particularly robotic-assisted techniques, have been developed to reduce complications. The single-port (SP) robotic platform, combined with indocyanine green (ICG) fluorescence imaging, may further enhance surgical precision and reduce operative morbidity. However, clinical experience remains limited.

Case presentation:

A 42-year-old man initially presented with persistent glans ulcer treated as chronic balanoposthitis. Following biopsy confirmed squamous cell carcinoma. The initial imaging showed no lymph node involvement. Despite recommendation for early surgical management, the patient declined surgical intervention. The disease subsequently progressed, requiring partial and later total penectomy due to local recurrence.

With evidence of pT3 stage penile cancer, the patient underwent single-port robotic-assisted bilateral ilio-inguinal lymphadenectomy with ICG fluorescence guidance. The surgery was performed through a single 3-cm incision at each groin. The articulating instruments of the SP platform allowed for delicate dissection within the confined femoral triangle (Fig. 1). Intraoperatively, ICG was injected intradermally and enabled real-time visualization of lymphatic drainage pathways and facilitated accurate identification of lymph nodes, allowing more precise dissection (Fig. 2).

Histopathological analysis demonstrated metastatic involvement of bilateral inguinal lymph nodes. On the right side, metastases were identified in the medial inguinal nodes (1/8), with no evidence of metastasis in the lateral nodes (0/5). On the left side, metastatic involvement was observed in the lateral (1/1) and deep inguinal nodes (1/1), whereas the medial nodes were negative (0/3). The distribution of metastatic nodes highlights the heterogeneous pattern of lymphatic spread. The patient subsequently received palliative radiotherapy and systemic chemotherapy.

Conclusion:
This case demonstrates the feasibility of single-port robotic-assisted bilateral ilio-inguinal lymphadenectomy with ICG guidance in advanced penile cancer. The SP platform may offer advantages including reduced wound burden, improved cosmetic outcomes, and enhanced surgical dexterity, while ICG-guided lymphatic mapping enhances lymph node identification during inguinal lymphadenectomy for penile cancer. This combined approach may represent a promising minimally invasive strategy for nodal management in penile cancer.