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Laparoscopic lymphocelectomy: a multi-institutional analysis
Insights
Laparoscopic lymphocelectomy is a safe and effective minimally invasive treatment for symptomatic lymphoceles, offering excellent long-term outcomes with low recurrence rates.
Area of Science:
- Minimally Invasive Surgery
- Urology
- Transplantation Surgery
Background:
- Symptomatic lymphoceles are uncommon, often leading to small, single-center studies.
- Multi-institutional data is crucial for understanding long-term outcomes of surgical interventions.
Purpose of the Study:
- To report a multi-institutional experience with laparoscopic lymphocelectomy.
- To evaluate the long-term outcomes of this minimally invasive procedure in a large patient cohort.
Main Methods:
- Data collected from 9 institutions with at least 5 laparoscopic lymphocelectomy cases.
- Analysis included patient demographics, operative details, complications, and recurrence rates.
Main Results:
- 81 patients (56 male, 25 female; mean age 41) underwent the procedure.
- Most lymphoceles (96%) occurred post-renal transplantation.
- Mean operative time was 123 minutes with minimal blood loss (43 ml); recurrence rate was 6% over 27 months mean follow-up.
Conclusions:
- Laparoscopic lymphocelectomy is a safe and effective procedure.
- It demonstrates excellent long-term outcomes and low recurrence rates.
- It serves as a superior alternative to open surgical approaches.
Purpose:
Because symptomatic lymphoceles are infrequent, single center studies generally report small numbers of patients. We report a multi-institutional experience with and long-term outcome following laparoscopic lymphocelectomy in 81 patients.
Materials And Methods:
Data were obtained from 9 institutions at which at least 5 cases of laparoscopic lymphocelectomy had been performed. Baseline patient demographics, operative time and blood loss, special operative adjunct techniques, postoperative course, convalescence, complications and lymphocele recurrence data were collected and analyzed.
Results:
A total of 56 men and 25 women with a mean age of 41 years were included in the study. Lymphocele formed after renal transplantation in 78 patients (96%) and after pelvic lymph node dissection in 3 (4%). Average operating time was 123 minutes with a mean blood loss of 43 ml. Omentopexy was performed in 11 cases (13.6%). No intraoperative stenting of the transplant ureter was performed. Intraoperative complications consisted of laryngospasm, bladder injury, inferior epigastric artery injury and mild renal capsule hematoma in 1 patient each. Conversion to open surgery was required for repair of bladder injury in 1, repair of preexisting hernia in 1, unusually thickened lymphocele wall in 1 and inaccessible lymphocele location in 4 cases. Mean time to ambulation and resumption of regular diet was 1 day, and mean hospital stay was 1.5 days. Postoperative complications included trocar site hernia in 1 and urinary retention in 2. Convalescence averaged 2.5 weeks. During a mean followup of 27 months 5 patients (6%) had lymphocele recurrence.
Conclusions:
Laparoscopic lymphocelectomy is safe, minimally invasive and effective. It is an excellent alternative to the conventional open surgical approach.
