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Peritoneal Window Technique: A Novel Sutureless Technique to Decrease the Rate of Symptomatic Lymphocele after

Eric Qualkenbush1, Yeonsoo S Lee1, Amanda Kahn1

  • 1Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA.

Journal of Endourology
|June 10, 2025
PubMed
Summary

A new sutureless technique, the peritoneal window (PWIN), significantly reduces symptomatic lymphoceles after robot-assisted radical prostatectomy with extended pelvic lymph node dissection. This method offers a practical approach to preventing complications from prostate cancer surgery.

Keywords:
lymphocelepelvic lymph node dissectionprostate cancerradical prostatectomyrobotic surgery

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Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (PLND) is standard for high-risk prostate cancer.
  • Pelvic lymph node dissection (PLND) can lead to lymphocele formation, causing complications like deep vein thrombosis (DVT), infection, and voiding dysfunction.
  • Existing methods to prevent lymphoceles lack widespread adoption or are not sutureless.

Purpose of the Study:

  • To introduce and evaluate the efficacy of a novel, sutureless peritoneal window (PWIN) technique.
  • To assess PWIN's effectiveness in preventing symptomatic lymphoceles following extended PLND during RARP.

Main Methods:

  • Retrospective review of 199 patients with high-risk prostate cancer undergoing RARP with extended PLND (2018-2024).
  • PLND performed using standard bipolar cautery.
  • The PWIN technique involves excising a 3x5 cm window over the lymphadenectomy bed to maintain lymphatic communication with the abdominal cavity.

Main Results:

  • Symptomatic lymphoceles (SLs) occurred in 10.9% (5/46) of patients in the standard technique group versus 2.0% (3/153) in the PWIN group (p=0.017).
  • The PWIN technique demonstrated a statistically significant reduction in SL incidence.
  • No significant differences were observed in symptomology or treatment requirements for lymphoceles between the groups.

Conclusions:

  • The sutureless peritoneal window (PWIN) technique significantly decreases symptomatic lymphoceles after extended PLND.
  • PWIN presents a practical, time-efficient, and cost-effective method for lymphocele prophylaxis.
  • Further prospective studies are recommended to validate these findings.