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Collins AP, Freise CE, Hiramoto J, Clark AJ, Theologis AA. Abdominal lymphocele following multi-level anterior lumbar interbody fusion (ALIF) managed with a laparoscopic peritoneal window: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2858-2863. [PMID: 38147084 DOI: 10.1007/s00586-023-08072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/14/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Lymphocele formation following anterior lumbar interbody fusion (ALIF) is not common, but it can pose diagnostic and treatment challenges. The purpose of this case is to report for the first time the treatment of a postoperative lymphocele following a multi-level ALIF using a peritoneal window made through a minimally invasive laparoscopic approach. METHODS Case report. RESULTS A 74-year-old male with a history of prostatectomy and pelvic radiation underwent a staged L3-S1 ALIF (left paramedian approach) and T10-pelvis posterior instrumented with L1-5 decompression/posterior column osteotomies for degenerative scoliosis and neurogenic claudication. Three weeks after surgery, swelling of the left abdomen and entire left leg was reported. Computed tomography of the abdomen/pelvis demonstrated a large (19.2 × 12.0 × 15.4 cm) retroperitoneal fluid collection with compression of the left ureter and left common iliac vein. Fluid analysis (80% lymphocytes) was consistent with a lymphocele. Percutaneous drainage for 4 days was ineffective at clearing the lymphocele. For more definitive management, the patient underwent an uncomplicated laparoscopic creation of a peritoneal window to allow passive drainage of lymphatic fluid into the abdomen. Three years after surgery, he had no back or leg pain, had achieved spinal union, and had no abdominal swelling or left leg swelling. Advanced imaging also confirmed resolution of the lymphocele. CONCLUSIONS In this case report, creation of a peritoneal window minimally invasively via a laparoscope allowing passive drainage of lymphatic fluid into the abdomen was safe and effective for management of an abdominal lymphocele following a multi-level ALIF.
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Affiliation(s)
- Andrew P Collins
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Christopher E Freise
- Division of Transplant Surgery, Department of Surgery, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Jade Hiramoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, UCSF, San Francisco, CA, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
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Covas Moschovas M, Helman T, Reddy S, Bhat S, Rogers T, Sandri M, Noel J, Patel V. Minimally Invasive Lymphocele Drainage Using the Da Vinci Single-Port Platform: Step-By-Step Technique of a Prostate Cancer Referral Center. J Endourol 2021; 35:1357-1364. [PMID: 33724057 DOI: 10.1089/end.2020.1175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Some reports in the literature describe lymphocele formation in as much as half of patients after pelvic lymph node dissection (PLND) in robot-assisted radical prostatectomy (RARP), with 1%-2% requiring intervention. Several treatment modalities for symptomatic lymphoceles are available, including percutaneous drainage, sclerosing agents, and surgical marsupialization, typically performed by laparoscopy or with a multiport robotic platform. The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe and illustrate, for the first time, the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the da Vinci® Single Port (SP). Materials and Methods: We describe the outcomes of three patients who underwent lymphocelectomy and marsupialization with the da Vinci SP for symptomatic lymphoceles after RARP and PLND with the da Vinci Xi. Results: Operative time for cases 1, 2, and 3 was 84, 80, and 79 minutes. The blood loss for each surgery was 25 mL. Patient 2 was discharged in 3 days, whereas patients 1 and 3 were discharged in 4 days. No intraoperative or postoperative complications were reported. All patients had their drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months (3.5-15.8). No patients were readmitted or had lymphocele recurrence. Conclusion: Da Vinci SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac, reducing the number of days with abdominal drains, and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.
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Affiliation(s)
- Marcio Covas Moschovas
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Talia Helman
- Department of Urology, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Sunil Reddy
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Seetharam Bhat
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Travis Rogers
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Jonathan Noel
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Vipul Patel
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
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Khoder WY, Becker AJ, Seitz M, Haseke N, Schlenker B, Stief CG. Modified laparoscopic lymphocele marsupialization for the treatment of lymphoceles after radical prostatectomy: first results. J Laparoendosc Adv Surg Tech A 2011; 21:145-8. [PMID: 21375423 DOI: 10.1089/lap.2010.0327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe a simple modification of the laparoscopic pelvic lymphocele marsupialization (LL) following radical prostatectomy lymphoceles (RP-LC). PATIENTS AND METHODS Forty-eight patients (57-76 years) with symptomatic RP-LC underwent surgery in our institute. This was through an open approach in 6 (open drainage [OL]) and LL in rest of the patients (12 with 3 [LL3] and 30 with 2 [LL2] trocars). All except 2 patients were refractory to percutaneous tube drainage and/or sclerotherapy. Pelvic ultrasound and/or computed tomography scans revealed LC size (4 × 5-11 × 12 cm) and volumes (100-1100 mL). RESULTS All surgeries were uneventful with an operative time of 15-60 minutes for LL and 35-90 minutes for OL and it became shorter with increasing experience with LL2 (15-25 minutes). Mean hospitalization time was 2.3 and 8 days after LL (LL2 and LL3) and OL, respectively. LC were at the right side in 10 patients, at the left side in 6, and at both sides in 14. Postoperative ultrasound revealed primary success in all cases. No patient developed recurrence of or had treatment for lymphocele during a mean follow-up time of 19 months. CONCLUSION LL2 is a simple, feasible, and safe procedure that could be used as a first-line treatment for large, noninfected symptomatic or refractive RP-LC.
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Affiliation(s)
- Wael Y Khoder
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
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Layman RE, McNally M, Kilian C, Linn J, Roza A, Johnson CP, Adams MB, Shames BD. Does Opening the Peritoneum at the Time of Renal Transplanation Prevent Lymphocele Formation? Transplant Proc 2006; 38:3524-6. [PMID: 17175321 DOI: 10.1016/j.transproceed.2006.10.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The occurrence of lymphocele formation following renal transplantation is variable, and the optimal approach to treatment remains undefined. Opening the peritoneum at the time of transplantation is one method of decreasing the incidence of lymphocele formation. The purpose of this study was to determine whether creating a peritoneal window at the time of transplantation decreases the incidence of lymphocele formation. METHODS We performed a retrospective review of renal transplants conducted at our institution between 2002 and 2004. Records were reviewed to obtain details regarding opening of the peritoneum at the time of transplant and occurrence of lymphocele. Every patient underwent routine ultrasound imaging in the peri-operative period. Graft dysfunction secondary to the lymphocele was the primary indication for intervention. Data were analyzed by chi-square. RESULTS During the initial transplant the peritoneum was opened in 35% of patients. The overall incidence of fluid collections, identified by ultrasound, was 24%. Opening the peritoneum did not decrease the incidence of lymphocele. However, more patients with a closed peritoneum required an intervention for a symptomatic lymphocele. In the 11 patients with an open peritoneum and a fluid collection, only one required an intervention. In patients whose peritoneum was left intact, 24% of fluid collections required intervention. Graft survival was equivalent. CONCLUSION Creating a peritoneal window at the time of transplantation did not decrease the overall incidence of postoperative fluid collections. However, forming a peritoneal window at the time of transplantation did decrease the incidence of symptomatic lymphocele.
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Affiliation(s)
- R E Layman
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53208, USA.
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Pepper RJ, Pati J, Kaisary AV. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int 2005; 95:772-5. [PMID: 15794780 DOI: 10.1111/j.1464-410x.2005.05398.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the incidence and treatment of lymphoceles after retropubic radical prostatectomy (RP). PATIENTS AND METHODS Up to January 2004, 260 patients who had a retropubic RP in one institution by one surgeon were assessed retrospectively, using the patients' notes or the computerized results system to determine whether a lymphocele was suspected and then confirmed by imaging studies (computed tomography or ultrasonography). RESULTS Nine patients developed symptomatic lymphoceles; eight of these were detected by imaging. Four lymphoceles required intervention while the remainder regressed spontaneously. No complications were reported in the group that was treated. CONCLUSION The rate of symptomatic lymphocele formation was low after RP, with an overall incidence of 3.5%. Ultrasonography was effective in detecting lymphoceles and ultrasonographically guided percutaneous drainage an effective treatment.
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Affiliation(s)
- Ruth J Pepper
- Department of Urology, Royal Free Hospital, London, UK
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Chin AI, Ragavendra N, Hilborne L, Gritsch HA. Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation. J Urol 2003; 170:380-3. [PMID: 12853780 DOI: 10.1097/01.ju.0000074940.12565.80] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Fibrin sealant is used in various surgical fields for hemostasis and as an adhesive to approximate tissues. Its use was recently reported as a sclerosing agent for percutaneous treatment of lymphoceles following renal transplantation. We report on the use of fibrin glue sclerotherapy at this institution for the management of renal transplant related lymphoceles. MATERIALS AND METHODS We reviewed the records of 8 patients at a single institution with lymphoceles after renal transplantation treated with percutaneous fibrin glue sclerosis. RESULTS Treatment success was achieved in 6 patients (75%), with resolution of lymphoceles assessed with clinical and imaging findings. Four patients (50%) required 2 applications of fibrin sealant, with 2 (25%) subsequently requiring surgical management of the lymphoceles. Clinical followup averaged 27.7 months (range 4 to 44). Complications included lymphocele recurrence, clogging of drainage catheters and catheter dislodgement. CONCLUSIONS The experience of 8 patients suggests that fibrin glue sclerotherapy may be considered a safe and effective method of treating symptomatic lymphoceles when simple percutaneous drainage has failed. The percutaneous approach does not require hospital admission and is less invasive than surgical treatment.
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Affiliation(s)
- Arnold i Chin
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA
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Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis 2001; 33 Suppl 1:S53-7. [PMID: 11389523 DOI: 10.1086/320905] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The most frequent infectious complication after renal transplantation is urinary tract infection. This article deals with antimicrobial prophylaxis, treatment of early and relapsing urinary tract infections, and management of asymptomatic bacteriuria in renal transplant patients. The incidence of lymphocele after renal transplantation varies, and its treatment is still controversial. Management options are discussed.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Brown ED, Chen MY, Wolfman NT, Ott DJ, Watson NE. Complications of renal transplantation: evaluation with US and radionuclide imaging. Radiographics 2000; 20:607-22. [PMID: 10835115 DOI: 10.1148/radiographics.20.3.g00ma14607] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Following renal transplantation, patients are often evaluated with ultrasonography (US) or radionuclide imaging to assess renal function and the presence of possible complications. Both modalities are inexpensive, noninvasive, and nonnephrotoxic. A basic understanding of the surgical techniques commonly used for renal transplantation is useful when imaging these patients in order to recognize complications and to direct further imaging or intervention. The most frequent complications of renal transplantation include perinephric fluid collections; decreased renal function; and abnormalities of the vasculature, collecting system, and renal parenchyma. Perinephric fluid collections are common following transplantation, and their clinical significance depends on the type, location, size, and growth of the fluid collection, features that are well-evaluated with US. Causes of diminished renal function include acute tubular necrosis, rejection, and toxicity from medications. Radionuclide imaging is the most useful modality for assessing renal function. Vascular complications of transplantation include occlusion or stenosis of the arterial or venous supply, arteriovenous fistulas, and pseudoaneurysms. Although the standard for evaluating these vascular complications is angiography, US is an excellent noninvasive method for screening. Other transplant complications such as abnormalities of the collecting system and renal parenchyma are well-evaluated with both radionuclide imaging and US.
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Affiliation(s)
- E D Brown
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1088, USA
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Bischof G, Rockenschaub S, Berlakovich G, Längle F, Mühlbacher F, Függer R, Steininger R. Management of lymphoceles after kidney transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00970.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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