Squamous cell carcinoma (SCC) of the penis is a rare urological malignancy in both the United States and Europe [1]. Patients with clinically negative groins but high-risk disease (pathologic T1b disease or greater) have been managed via dynamic sentinel lymph node biopsy (DSLNB) or by prophylactic inguinal lymph node dissection (ILND) [2,3]. Contemporary data suggests that patients undergoing prophylactic dissection have significantly improved disease-specific survival outcomes compared to those treated at the time of palpable node development [4,5]. However, ILND is not without risk and carries significant morbidity, primarily related to surgical wound complications, lymphedema, and infection. Traditional open approaches to ILND are associated with overall complication rates typically exceeding 50% in larger series, with major complications reported at greater than 30% [6], [7], [8]. Refinements in surgical techniques have lowered the reported complication incidence at high-volume institutions, but the overall incidence remains high [9].

Robotic-assisted inguinal lymph node dissection (RAIL) was first described by Josephson et al. in 2009 [10]. Over the subsequent decade of practice, a few studies have reported on the oncological efficacy, complication rate, and comparison with traditional open techniques. Early experiences suggested comparable oncologic outcomes, although long-term data is still needed [11]. Subsequent reporting on complication rates between the minimally invasive and open modalities has suggested less morbidity with RAIL. This has ranged from approximately 20% in early reports to a 2% reported incidence of major complications in a more recently reported series [12,13].

We sought to report on a cohort of patients undergoing RAIL at MDACC as a staging procedure among cN0 patients and to compare the outcomes in these patients to a contemporary cN0 group undergoing a standard open superficial inguinal lymph node dissection (OSILND) over the same period at two tertiary referral centers. We hypothesized that the RAIL cohort would exhibit a lower incidence of wound related complications.