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Introduction
Lymphocele formation is a known complication of pelvic lymph node dissection (PLND) during robotic-assisted prostatectomy. While most are clinically insignificant, 5-15% will require percutaneous or surgical drainage. We developed a novel technique to preemptively create a peritoneal window utilizing the existing peritoneal surface lateral to the bladder.
Materials and Methods
We retrospectively evaluated 106 consecutive patients undergoing RALP with limited PLND between May 28, 2010 and March 22, 2012. Group A: 75 patients, PLND with standard techniques. Group B: 36 patients, PLND with peritoneal window. The window was created by advancing the existing peritoneal surface lateral to the medial obliterated ligament around the lateral surface of the ipsilateral bladder using vicryl sutures (accompanying video will be presented). Preventing the bladder from scarring over the lymphadenectomy bed as such allows for continuous drainage of lymphatic fluid into the peritoneal cavity. All patients had a cystogram performed 7-12 days after the surgery. Lymphocele formation rates were compared (based on symptoms, initial cystogram findings, and CT scan confirmation).
Results
The two groups were statistically equivalent in terms of PSA, age, EBL, BMI, Gleason score, prostate size, or heparin use. Lymphocele formation occurred in 4/75 (5.3%) Group A patients and 0/36 Group B patients (p = 0.3022, Fisher's exact test). Median time till lymphocele detection in Group A was 11.5 days. Median follow up in Groups A and B were 378 and 73 days respectively (p <0.0001).
Conclusions
Strategic fixation of existing peritoneum during transperitoneal RALP with PLND may be a novel technique to prevent or decrease lymphocele formation. Given the small sample size and lack of power, statistical significance was not demonstrated. Nevertheless, this simple surgical technique warrants ongoing investigation.