Peritoneal Flap Following Lymph Node Dissection in Robotic Radical Prostatectomy: A Novel "Bunching" Technique

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) is standard for intermediate/high-risk prostate cancer.
• Symptomatic lymphoceles are a common postsurgical complication, increasing patient morbidity.

Purpose of the Study:

• To introduce and evaluate a novel Peritoneal Bladder Flap Bunching (PBFB) technique.
• To assess the efficacy of PBFB in reducing clinically significant lymphoceles after RARP and PLND.

Main Methods:

• A comparative study of 2267 patients undergoing RARP and PLND.
• Group 1: 567 patients with PBFB technique. Group 2: 1700 patients without PBFB.
• Propensity score matching (1:3 ratio) was used to compare outcomes including lymphocele formation and symptomatic lymphoceles.

Main Results:

• No significant difference in overall lymphocele rates between groups (24% vs 20.9%, p=0.14).
• Crucially, 0% of patients in the PBFB group developed symptomatic lymphoceles compared to 2.2% in the non-flap group (p=0.01).

Conclusions:

• The Peritoneal Bladder Flap Bunching (PBFB) technique is effective in eliminating symptomatic lymphoceles post-RARP.
• PBFB shows promising short-term results for managing lymphocele complications in prostate cancer surgery.