V10-06: A NOVEL TECHNIQUE FOR PREVENTION OF LYMPHOCELES DURING TRANSPERITONEAL ROBOTIC ASSISTED PELVIC LYMPH NODE DISSECTION
VideoIntroductions and Objectives
Lymphocele formation is a known complication of pelvic lymph node dissection (PLND) after robotic-assisted radical prostatectomy (RARP). We developed a novel technique to prevent lymphocele formation, utilizing the existing peritoneum of the bladder.
We evaluated 155 consecutive patients undergoing RARP with PLND over 24 months. Group A included the first 77 patients with PLND using standard technique (no peritoneal flap). Group B included the subsequent 78 patients with PLND and peritoneal interposition flap. The peritoneal interposition flap is developed from the redundant peritoneal surface after dropping down the bladder and using the tissue lateral to the obliterated ligament. At the end of the case after the vescico-urethral anastomosis is completed, the flap is brought to the most dependent portion of the pelvis (posterior and caudal) by rotating and advancing the peritoneal flap around the lateral surface of the ipsilateral bladder. The flap is fixed to the bladder using at least two interrupted Vicryl sutures. This prevents the bladder adipose tissue from contacting the lymph node dissection bed and scaring down. The window that is created allows the continuous egress of lymphatic fluid into the peritoneal cavity to be reabsorbed. A cystogram was performed in 91% of the patients 7-14 days after the surgery. Lymphocele formation rates were compared (based on symptoms, cystogram findings, and radiographic confirmation).
The two groups were statistically equivalent in terms of PSA, age, blood loss, body mass index, Gleason score, prostate size, pathology, and heparin administration. Symptomatic lymphocele formation occurred in 9/77 (11.6%) Group A patients and in 0/77 Group B patients (p = 0.003). Mean time to lymphocele detection in Group A was 30.4 days. Mean follow up in Groups A and B were 374.3 and 113.8 days respectively (p
Strategic rotation and fixation of a peritoneal flap around the lateral aspect of the bladder during transperitoneal RARP with PLND is a novel technique to prevent symptomatic lymphocele formation. Given the sample size and single institutional study, a prospective randomized, multi-institutional trial is planned.