To explore the feasibility and advantages of three hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection in patients with penile cancer.

The data of patients with penile cancer who underwent three-hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection in the First Affiliated Hospital of University of Science and Technology of China from March 2019 to July 2021 were analyzed retrospectively. The skin and subcutaneous area were cut 1cm below the umbilicus, and the subcutaneous space was established with a self-made balloon. A 12 cm trocar and a 5 cm trocar were inserted into the McBurney's point and the inverse McBurney's point, respectively, and a 10 cm trocar was inserted into the infra-umbilical for endoscopic observation. The inguinal ligament, superficial fascia and deep fascia were searched under the fat layer in front of the abdominal wall. Marked by these anatomical structures, shallow and deep inguinal lymph nodes were isolated. The same procedure was performed on the left inguinal area.

All the 20 patients were completed the operations successfully, the operation time was (122±22) min (excluding the partial penis resection time), the amount of blood loss was (49±7) ml, the postoperative hospital stay was (7.3±2.0) days, and the postoperative drainage tube removal time was (7.9±1.3) days. The number of left dissected lymph nodes was 11.5(5-21), and the number of right dissected lymph nodes was 10(2-19). Twenty patients were followed up for 3 to 28 months. Two patients had serious lymphatic leakage after operations, which improved after symptomatic treatment with enhanced nutrition and prolonged the retention of drainage tube removed. No recurrence, metastasis or serious adverse complications occurred in the other patients during follow-up.

Three hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection is a safe and effective minimally invasive treatment, which is worthy of clinical application.