A Peritoneal Purse-String Suture Prevents Symptomatic Lymphoceles in Retzius-Sparing Robot-Assisted Radical...

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robotic-assisted radical prostatectomy (RARP) with a retzius-sparing approach is increasingly common.
• Symptomatic lymphoceles are a frequent complication following RARP, particularly with pelvic lymph node dissection.
• The peritoneal purse-string suture (PPSS) technique is proposed to mitigate lymphocele formation.

Purpose of the Study:

• To evaluate the efficacy of the novel peritoneal purse-string suture (PPSS) technique.
• To assess the impact of PPSS on symptomatic lymphocele rates after retzius-sparing RARP with extended pelvic lymph node dissection (ePLND).

Main Methods:

• Retrospective evaluation of two patient cohorts undergoing RARP with ePLND.
• Comparison of outcomes between a control group (n=145) and a group using the PPSS technique (n=91).
• The PPSS technique involves simultaneous closure of the prostatectomy opening and widening of lymphadenectomy fields using a single suture.

Main Results:

• No significant difference in overall postoperative lymphocele formation (22% PPSS vs. 27% control).
• A significantly lower rate of symptomatic lymphoceles was observed in the PPSS group (3% vs. 10%, p=0.047).
• Comparable rates of Clavien-Dindo grade I-III complications between groups.

Conclusions:

• The peritoneal purse-string suture (PPSS) is a feasible and effective technique.
• PPSS demonstrably reduces symptomatic lymphoceles in patients undergoing retzius-sparing RARP with ePLND.
• This technique may improve patient outcomes by lowering the incidence of symptomatic lymphoceles.