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Di Gianfrancesco L, Alessandro C, Paolo C, Davide DM, Eugenio M, Angelo P. Robot-Assisted Treatment of Symptomatic Lymphocele Postradical Prostatectomy and Lymphadenectomy in the Era or Robotic Surgery: Narrative Review. Technol Cancer Res Treat 2023; 22:15330338221145248. [PMID: 37350154 PMCID: PMC10291396 DOI: 10.1177/15330338221145248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background: Pelvic lymphnode dissection (PLND) is an integral part of surgical treatment for localized intermediate and high-risk prostate cancer. The most common complication of PLND is lymphocele formation. In the majority of cases the development of lymphoceles is clinically asymptomatic but in case of symptomatic/infected lymphocele an active treatment is required. The aim of this article is to analyse the current evidence on the treatment of symptomatic/infected lymphocele trough robotic approach. Materials and Methods: The search was applied to PubMed, EMBASE, and Cochrane databases with following terms: "lymphocele", "symptomatic", "infected", "robot-assisted AND radical prostatectomy", "robot-assisted", "treatment". Results: The search identified three series focusing on the treatment by robot-assisted approach of symptomatic and/or infected lymphocele. The main and most frequent reason for performing the robotic treatment was an infected lymphocele, the median time from robot-assisted radical prostatectomy and PLND to robotic treatment of lymphocele was 118 days (range 30-240). Robot-assisted treatment was successful in all reports. Conclusions: The drainage of lymphocele with the robot-assisted approach appeared safe, feasible, and with satisfactory outcomes for the definitive treatment of symptomatic/infected lymphocele.
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Affiliation(s)
- Luca Di Gianfrancesco
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Crestani Alessandro
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Corsi Paolo
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - De Marchi Davide
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Miglioranza Eugenio
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Porreca Angelo
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
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D’Anastasi M, Ebenberger S, Alghamdi A, Helck A, Herlemann A, Stief C, Khoder W, Trumm CG, Stahl R. Technical Outcome, Clinical Success, and Complications of Low-Milliampere Computed Tomography Fluoroscopy-Guided Drainage of Lymphoceles Following Radical Prostatectomy with Pelvic Lymph Node Dissection. Diagnostics (Basel) 2022; 12:diagnostics12102394. [PMID: 36292083 PMCID: PMC9600916 DOI: 10.3390/diagnostics12102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
To evaluate the technical outcome, clinical success, and safety of low-milliampere CT fluoroscopy (CTF)-guided percutaneous drain (PD) placement in patients with lymphoceles following radical prostatectomy (RP) with pelvic lymph node dissection (LND). This retrospective analysis comprised 65 patients with PD placement in lymphoceles following RP under low-milliampere CTF guidance. Technical and clinical success were evaluated. Complications within a 30-day time interval associated with CTF-guided PD placement were classified according to SIR. Patient radiation exposure was quantified using dose-length products (DLP) of the pre-interventional planning CT scan (DLPpre), of the sum of intra-interventional CT fluoroscopic acquisitions (DLPintra) and of the post-interventional control CT scan (DLPpost). Eighty-nine lymphoceles were detected. Seventy-seven CT-guided interventions were performed, with a total of 92 inserted drains. CTF-guided lymphocele drainage was technically successful in 100% of cases. For all symptomatic patients, improvement in symptoms was reported within 48 h after intervention. Time course of C-reactive protein and Leucocytes within 30 days revealed a statistically significant (p < 0.0001) decrease. Median DLPpre, DLPintra and DLPpost were 431 mGy*cm, 45 mGy*cm and 303 mGy*cm, respectively. Only one minor complication (self-resolving haematoma over the bladder dome; SIR Grade 2) was observed. Low-milliampere CTF-guided drainage is a safe treatment option in patients with lymphoceles following RP with pelvic LND characterized by high technical and good clinical success rates, which provides rapid symptom relief and serves as definite treatment or as a bridging therapy prior to laparoscopic marsupialisation.
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Affiliation(s)
- Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Correspondence: ; Tel.: +356-2545-6783
| | - Simone Ebenberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Abdulmajeed Alghamdi
- Department of Urology, Albaha University, Albaha 65779-7738, Saudi Arabia
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Andreas Helck
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Radiology and Neuroradiology, Hirslanden Klinik Im Park, Seestrasse 220, 8027 Zürich, Switzerland
| | - Annika Herlemann
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Wael Khoder
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Department of Urology, Helios-Amper Klinikum Dachau, Krankenhausstraße 15, 85221 Dachau, Germany
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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Magistro G, Tuong-Linh Le D, Westhofen T, Buchner A, Schlenker B, Becker A, Stief CG. Occurrence of symptomatic lymphocele after open and robot-assisted radical prostatectomy. Cent European J Urol 2021; 74:341-347. [PMID: 34729223 PMCID: PMC8552934 DOI: 10.5173/ceju.2021.3.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to evaluate the prevalence and predictors of symptomatic lymphocele after open retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP). Material and methods A total of 472 patients undergoing RRP (n = 241) or RARP (n = 231) were retrospectively analyzed with a 2-year follow-up for age, body mass index (BMI), total serum prostate-specific antigen (PSA), lymphocele formation and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of symptomatic lymphocele. Results Patients undergoing RRP developed significantly less overall lymphoceles than after RARP (8.2% vs 16.7%; p = 0.049), but no difference was determined for symptomatic events requiring intervention (7.4% vs 11.7%, p = 0.315). Although more pelvic lymph node dissections (PLND) were performed during RARP (70.1% vs 50.6%; p <0.001), significantly more cases with lymphatic invasion were observed after RRP (18% vs 6.2%, p = 0.002). The median lymph node yield during RRP and RARP were 11 and 10, respectively (p = 0.381). In multivariate logistic regression, we identified the number of dissected lymph nodes (n = 11) (OR 1.1; 95% Cl 1.055 - 1.147; p = 0.001), the Gleason score ≥ 8 (OR 4.7; 95% Cl 2.365 – 9.363; p = 0.001) and the total PSA ≥10 ng/ml (OR 1.05; 95% Cl 1.02 – 1.074; p = 0.001) as independent predictors for the development of symptomatic lymphocele. Conclusions Next to an extended lymph node yield, high-grade disease was associated with a higher risk to develop symptomatic lymphocele irrespective of the technical approach. The identification of risk factors might prove valuable in clinical practice when assessing and counselling patients considering surgical treatment of prostate cancer.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doan Tuong-Linh Le
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Pose RM, Knipper S, Würnschimmel C, Tennstedt P, Michl U, Maurer T, Graefen M, Steuber T. Significant reduction of lymphoceles after radical prostatectomy and pelvic lymph node dissection. BJU Int 2021; 128:728-733. [PMID: 34036733 DOI: 10.1111/bju.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/23/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To reduce the risk of symptomatic lymphocele (SLC), we present a technique using peritoneal fenestration that allows lymphatic fluid to drain into the abdomen, as SLC formation after open retropubic radical prostatectomy (ORP) with pelvic lymph node dissection (PLND) is a common adverse event. PATIENTS AND METHODS We identified 1513 patients who underwent ORP with PLND between July 2018 and November 2019. Of those, 307 patients (20.3%) received peritoneal fenestration and 1206 (79.7%) no fenestration. The rate of LCs and the necessity for intervention were analysed by uni- and multivariable logistic regression (MLR) models. A propensity score matching was performed, as well. RESULTS The median (interquartile range [IQR]) age was 65 (60-70) years. A median (IQR) of 16 (10-22) lymph nodes were dissected, 22 vs 14 lymph nodes in the fenestration vs non-fenestration group (P < 0.001). Overall, 189 patients (12.5%) were diagnosed with a LC after ORP, while 21 patients (6.8%) in the fenestration and 168 (13.9%) in the non-fenestration group had LCs (P = 0.001). In 70 patients (4.7%), LCs required further intervention, categorised as Clavien-Dindo Grade IIIa/b, with a smaller proportion in the fenestration group (2.9% vs 5.0% in the non-fenestration group, P < 0.001). There were no Clavien-Dindo Grade IV or V complications, in particular no abdominal complications in association with peritoneal fenestration observed. In MLR, peritoneal fenestration was associated with a reduced risk of LCs (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.2-0.5; P < 0.001). The risk reduction was also shown after propensity score matching (OR 0.38, 95% CI 0.21-0.68; P = 0.001). The number needed to treat was 14. CONCLUSIONS Peritoneal fenestration may decrease the rate of SLC after ORP with (extended) PLND. Therefore, it should be part of the operative strategy.
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Affiliation(s)
- Randi M Pose
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Würnschimmel
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Michl
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Goßler C, May M, Breyer J, Stojanoski G, Weikert S, Lenart S, Ponholzer A, Dreissig C, Burger M, Gilfrich C, Bründl J, Rosenhammer B. High BMI, Aggressive Tumours and Long Console Time Are Independent Predictive Factors for Symptomatic Lymphocele Formation after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection. Urol Int 2021; 105:453-459. [PMID: 33794533 DOI: 10.1159/000514439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lymphocele (LC) formation is a common complication which may cause severe symptoms after robot-assisted radical prostatovesiculectomy (RARP) with concomitant pelvic lymph node dissection (PLND). Compared to open radical prostatectomy, the amount of data on potential risk factors for LC formation is still limited. The aim of the present study was to identify risk factors for symptomatic LC formation (sLC) after RARP with PLND. METHODS We used the data of a prospective multicentre series of 232 RARP patients which were treated between March 2017 and December 2017. The primary endpoint was the presence of sLC within 90 days. Asymptomatic LC (aLC) formation was also recorded. We evaluated clinical, perioperative, and histopathological criteria and compared their distribution in patients with and without post-operative sLC. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify potential predictors for LC formation. Regarding the influence of patients' BMI, 2 models were calculated: BMI continuously (model 1) and BMI dichotomized with cut-off 30 kg/m2 (WHO definition, model 2). RESULTS Post-operative sLC was present in 21 patients (9.1%), while aLC was detected in 49 patients (21.1%) 90 days after RARP with PLND. Patients with sLC showed higher median baseline PSA levels (9.8 vs. 8.1 ng/mL), higher prevalence of obesity (BMI >30; 42.9 vs. 19.9%), and longer median console time (180 vs. 165 min) compared to patients without sLC. On MVA higher BMI {model 1: OR 1.145 (confidence interval [CI] 1.025-1.278); model 2: OR 2.761 (1.045-7.296)}, longer console time (model 1: OR 1.013 [1.005-1.021]; model 2: OR 1.013 [1.005-1.020]) and an ISUP grade ≥3 (model 1: OR 3.247 [1.182-8.917]; model 2: OR 2.791 [1.050-7.423]) were identified as independent predictors for sLC development. CONCLUSION Patients with aggressive tumours and higher BMI should be informed about a potentially increased risk for sLC formation. In case of a long console time, a close and regular follow-up should be considered to check for LC development.
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Affiliation(s)
- Christopher Goßler
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Gjoko Stojanoski
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Steffen Weikert
- Department of Urology, Vivantes Humboldt Hospital, Berlin, Germany
| | - Sebastian Lenart
- Department of Urology and Andrology, St. John of God Hospital Vienna, Brothers of Mercy Hospital, Vienna, Austria
| | - Anton Ponholzer
- Department of Urology and Andrology, St. John of God Hospital Vienna, Brothers of Mercy Hospital, Vienna, Austria
| | | | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Bernd Rosenhammer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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Neuberger M, Kowalewski KF, Simon V, Wessels F, Siegel F, Worst TS, Westhoff N, von Hardenberg J, Kriegmair M, Michel MS, Honeck P, Nuhn P. Peritoneal flap for lymphocele prophylaxis following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: study protocol and trial update for the randomized controlled PELYCAN study. Trials 2021; 22:236. [PMID: 33781339 PMCID: PMC8008541 DOI: 10.1186/s13063-021-05168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Data from interventional studies suggest that a peritoneal flap after pelvic lymph node dissection (LND) during laparoscopic, robotic-assisted radical prostatectomy (RARP) may reduce the rate of symptomatic lymphoceles in transperitoneal approach. However, most of these studies are not conducted in a randomized controlled fashion, thus limiting their scientific value. A recent prospective, randomized, controlled trial (RCT) did not show superiority of a peritoneal flap while further trials are lacking. Therefore, the aim of the presented RCT will be to show that creating a peritoneal flap decreases the rate of symptomatic lymphoceles compared to the current standard procedure without creation of a flap. Methods/design PELYCAN is a parallel-group, patient- and assessor-blinded, phase III, adaptive randomized controlled superiority trial. Men with histologically confirmed prostate cancer who undergo transperitoneal RARP with pelvic LND will be randomly assigned in a 1:1 ratio to two groups—either with creating a peritoneal flap (PELYCAN) or without creating a peritoneal flap (control). Sample size calculation yielded a sample size of 300 with a planned interim analysis after 120 patients, which will be performed by an independent statistician. This provides a possibility for early stopping or sample size recalculation. Patients will be stratified for contributing factors for the development of postoperative lymphoceles. The primary outcome measure will be the rate of symptomatic lymphoceles in both groups within 6 months postoperatively. Patients and assessors will be blinded for the intervention until the end of the follow-up period of 6 months. The surgeon will be informed about the randomization result after performance of vesicourethral anastomosis. Secondary outcome measures include asymptomatic lymphoceles at the time of discharge and within 6 months of follow-up, postoperative complications, mortality, re-admission rate, and quality of life assessed by the EORTC QLQ-C30 questionnaire. Discussion The PELYCAN study is designed to assess whether the application of a peritoneal flap during RARP reduces the rate of symptomatic lymphoceles, as compared with the standard operation technique. In case of superiority of the intervention, this peritoneal flap may be suggested as a new standard of care. Trial registration German Clinical Trials Register DRKS00016794. Registered on 14 May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05168-x.
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Affiliation(s)
- M Neuberger
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K F Kowalewski
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - V Simon
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Wessels
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Siegel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Heinrich Lanz Centre for Digital Health, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - T S Worst
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - N Westhoff
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - J von Hardenberg
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M Kriegmair
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M S Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Honeck
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Nuhn
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Goßler C, Hillinger J, Burger M, Bründl J, Denzinger S, Gierth M, Breyer J. Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP). Transl Androl Urol 2021; 10:821-829. [PMID: 33718083 PMCID: PMC7947462 DOI: 10.21037/tau-20-1315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Lymphoceles are a common postoperative complication after radical prostatectomy with pelvic lymphadenectomy. Therapeutic options include cannulation and drainage (CD), drainage and instillation (DI), or laparoscopic fenestration (LF). The aim of this study was to investigate the epidemiology of symptomatic lymphoceles (SLC) and evaluate the treatment options. Methods We retrospectively analysed all patients who underwent robot-assisted radical prostatectomy (RARP) at our clinic from January 1, 2014 to December 31, 2018. All documented lymphoceles of these patients were recorded and analysed with regard to symptoms, possible infection and the treatment option (or options) chosen. Results We were able to include all 1,029 patients who underwent RARP in the aforementioned period of time. Of these, 18.1% were diagnosed with a lymphocele either when discharged or when readmitted and 6.9% experienced an SLC requiring treatment. Thirteen-point-seven percent of patients readmitted with SLC showed an accompanying thrombosis. Due to recurring or bilateral SLCs receiving different treatment options for each side, there was a total of 115 SLCs treated. CD was carried out in 102 cases. Twenty-point-six percent of patients were sufficiently treated this way, the rest required further treatment or experienced recurrences not requiring further treatment. DI was carried out in 56 cases. Of those patients, 46.4% were sufficiently treated. LF was carried out in 54 cases (either after CD, or after DI, or primarily). Of those patients, 98.1% were treated sufficiently. LF had a statistically significant higher success rate compared to CD and DI (P<0.001 respectively). Conclusions The study confirmed the significance of SLC as a common complication after RARP. LF turned out to be the most effective treatment option for SLC, while CD as well as DI have not been proven effective.
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Affiliation(s)
- Christopher Goßler
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Hillinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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8
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Zhang L, Li X, Wu H, Lv K, Zeng C, Song H. Endovascular stent treatment of the iliac vein stenosis caused by a pelvic lymphocele secondary to gynecologic malignancy. J Interv Med 2020; 3:192-194. [PMID: 34805933 PMCID: PMC8562170 DOI: 10.1016/j.jimed.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Over the past two years, 6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy. Patients had symptomatic lymphoceles induced lower limb edema. Poor treatment of symptomatic lymphoceles, compression symptoms persist, all patients were performed endovascular stent therapy, clinical symptoms of lower limb were completely relieved. Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy, endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.
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Affiliation(s)
- Li Zhang
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
| | - Xiang Li
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
| | - Huaping Wu
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
| | - Kaiping Lv
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
| | - Cunliang Zeng
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
| | - Huanhuan Song
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, 635000, PR China
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Ochiai K, Kaneko M, Nozawa H, Kawai K, Hata K, Tanaka T, Nishikawa T, Shuno Y, Sasaki K, Hiyoshi M, Emoto S, Murono K, Sonoda H, Ishihara S. Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study. Colorectal Dis 2020; 22:161-169. [PMID: 31454448 DOI: 10.1111/codi.14831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022]
Abstract
AIM Pelvic lymphocele is a common complication that develops after pelvic lymph node dissection. The incidence of pelvic lymphocele formation has been reported to be 10.5-51% after gynaecological or urological procedures. However, no evidence has been reported thus far with regard to the development of pelvic lymphocele following lateral pelvic lymph node dissection (LPND) for low rectal cancer. The aim of this study was to investigate the incidence of and risk factors for lymphocele formation after LPND for low rectal cancer and to examine its clinical management. METHOD We retrospectively analysed the incidence of and risk factors for pelvic lymphocele formation after LPND for rectal cancer in our hospital between January 2012 and December 2017. We also compared the size of the lymphocele between asymptomatic and symptomatic patients by using CT volumetry and examined its clinical management. RESULTS A total of 30 out of 98 patients (30.8%) developed pelvic lymphocele after rectal LPND. The number of resected nodes was significantly higher in patients with a pelvic lymphocele (P < 0.01). The median volume was significantly higher in patients with symptomatic pelvic lymphocele (P = 0.011). Among the nine symptomatic patients, two underwent CT-guided drainage, one underwent transurethral ureteral stent placement and one underwent laparoscopic marsupialization. CONCLUSION It is essential to keep in mind the possibility of pelvic lymphocele formation during follow-up of patients who undergo LPND, and to consider an appropriate treatment when these patients are symptomatic.
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Affiliation(s)
- K Ochiai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - M Kaneko
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Kawai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Hata
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Tanaka
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Y Shuno
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Sasaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - M Hiyoshi
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Emoto
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Sonoda
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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10
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Oyama H, Nagai T, Okamura T, Yanase T, Chaya R, Moritoki Y, Kobayashi D, Akita H, Yasui T. A case of laparoscopic fenestration surgery for pelvic lymphocele occurring after laparoscopic radical prostatectomy. J Rural Med 2019; 14:241-244. [PMID: 31788150 PMCID: PMC6877914 DOI: 10.2185/jrm.3001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 12/04/2022] Open
Abstract
A 76-year-old Japanese man visited a nearby medical clinic complaining of abdominal
distention. He had undergone extraperitoneal laparoscopic prostatectomy at our institution
5 months before the onset of abdominal distention. An imaging study revealed a large
cystic lesion, and biochemical examination of a sample obtained via cyst puncture led to a
diagnosis of lymphocele. As the lymphocele was resistant to puncture, drainage, and
sclerotherapy with minomycin, laparoscopic fenestration was performed. Although the
patient developed an adhesive ileus postoperatively, the cyst has not recurred.
Fenestration surgery is a feasible option for lymphocele refractory to various
conservative therapies.
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Affiliation(s)
- Hiroki Oyama
- Department of Urology, Anjo Kosei Hospital, Japan
| | | | | | | | | | | | | | | | - Takahiro Yasui
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Japan
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11
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Tsaur I, Thomas C. Risk factors, complications and management of lymphocele formation after radical prostatectomy: A mini-review. Int J Urol 2019; 26:711-716. [PMID: 30939628 DOI: 10.1111/iju.13964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 12/01/2022]
Abstract
Lymphocele formation is the most common adverse event of pelvic lymphadenectomy during radical prostatectomy for prostate cancer. Previous studies failed to favor one surgical technique over the other in terms of minimizing its rate. Data on risk factors for its development are still conflicting and warranting further research. In this mini-review, we aimed to scrutinize available evidence on these aspects and outline current achievements in lymphocele prevention approaches.
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Affiliation(s)
- Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Dresden, Dresden, Germany
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12
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Thomas C, Ziewers S, Thomas A, Dotzauer R, Bartsch G, Haferkamp A, Tsaur I. Development of symptomatic lymphoceles after radical prostatectomy and pelvic lymph node dissection is independent of surgical approach: a single-center analysis. Int Urol Nephrol 2019; 51:633-640. [DOI: 10.1007/s11255-019-02103-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/08/2019] [Indexed: 01/24/2023]
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13
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Hamada A, Hwang C, Fleisher J, Tuerk I. Microbiological evaluation of infected pelvic lymphocele after robotic prostatectomy: potential predictors for culture positivity and selection of the best empirical antimicrobial therapy. Int Urol Nephrol 2017; 49:1183-1191. [PMID: 28439680 DOI: 10.1007/s11255-017-1599-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine symptomatology and microbiology of infected lymphocele (LC) post-robotic-assisted radical prostatectomy and pelvic lymph node dissection (PLND) and to assess for potential predictors for LC fluid culture positivity. Secondly, to provide general recommendations about use of select antimicrobial therapy. METHODS This was a single-center, IRB-approved, retrospective, case series review conducted between October 2008 and October 2014. Data included symptomatology, microbiology of symptomatic LC in men post-robotic prostatectomy and PLND. Those with infected LC were compared to those men with symptomatic LC in the absence of infection. RESULTS Symptomatic LC was seen in 7% of men, and among those, infected LC was seen in 42%. Infected LC cultures showed predominance of G+ cocci such as S. aureus, coagulase-negative Staphylococcus species, S. pyogenes, S. fecalis and S. viridans. Monomicrobial infection was seen in 85%. Multivariate logistic regression showed leukocytosis [Odds: 12.3, p = 0.03, 95% CI (1.2-125)] was significant predictor for culture positivity, whereas trend toward significance for factors such CT findings of thickened walls around the LC +/- air. CONCLUSIONS LC infection following PLND for prostate cancer is usually monomicrobial and caused by Gram+ cocci. GI tract and skin flora are the main habitat. High index of suspicion of infected LC is undertaken in the presence of leukocytosis, fever and abnormal CT findings. Based upon our local hospital antibiogram, combination of IV ampicillin/sulbactam and vancomycin is suggested as the best initial empiric therapy in treating these patients.
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Affiliation(s)
- Alaa Hamada
- Division of Urology, Department of Surgery, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, 11 Nevins Street, MOB, Suite 303, Boston, MA, 02135, USA.
| | | | - Jorge Fleisher
- Division of Infectious Disease, Department of Medicine, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, Boston, MA, 02135, USA
| | - Ingolf Tuerk
- Division of Urology, Department of Surgery, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, 11 Nevins Street, MOB, Suite 303, Boston, MA, 02135, USA
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14
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Kaplan JR, Lee Z, Eun DD, Reese AC. Complications of Minimally Invasive Surgery and Their Management. Curr Urol Rep 2016; 17:47. [PMID: 27075019 DOI: 10.1007/s11934-016-0602-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Minimally invasive surgery, including both traditional laparoscopic and robot-assisted laparoscopic approaches, has increasingly become the standard of care for urologic abdominal and pelvic surgery. This is a comprehensive review of the contemporary literature regarding complications of laparoscopic and robotic urologic surgery. The review highlights pertinent studies with the goal of providing the minimally invasive urologic surgeon with an up-to-date overview of general and procedure-specific complications and their management.
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Affiliation(s)
- Joshua R Kaplan
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Ziho Lee
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Daniel D Eun
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Adam C Reese
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA.
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15
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Potretzke AM, Wong KS, Shi F, Christensen W, Downs TM, Abel EJ. Highest risk of symptomatic venous thromboembolic events after radical cystectomy occurs in patients with obesity or nonurothelial cancers. Urol Ann 2015; 7:355-60. [PMID: 26229325 PMCID: PMC4518374 DOI: 10.4103/0974-7796.152050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/24/2014] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Venous thromboembolism (VTE) is a common cause of postoperative morbidity and mortality in cystectomy patients. AIMS The aim of this study is to identify variables associated with risk of developing deep venous thrombosis (DVT) or pulmonary embolism (PE) within 90 days after radical cystectomy (RC). SETTING AND DESIGN Retrospective chart review of patients undergoing RC from 2004 to 2011 at the University of Wisconsin. SUBJECTS AND METHODS Clinical variables collected for all RC patients. All patients received mechanical prophylaxis, and routine heparin prophylaxis began in 2010. STATISTICAL ANALYSIS USED Univariate and multivariate analyses were used to evaluate VTE association with known risk factors. RESULTS A total of 241 patients were identified with median age of 67.1 (interquartile range: 57.8-74.3) years. Body mass index (BMI) was ≥30 in 36.8% of patients. Median blood loss was 950 (600-1500) mL and 157/241 (65.2%) patients received a blood transfusion. CONCLUSIONS Patients with BMI ≥30 or nonurothelial cancer are at highest risk for postoperative VTE and should be considered for extended heparin prophylaxis.
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Affiliation(s)
- Aaron M Potretzke
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kelvin S Wong
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Fangfang Shi
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - William Christensen
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Tracy M Downs
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - E Jason Abel
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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16
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Lee HJ, Kane CJ. How to minimize lymphoceles and treat clinically symptomatic lymphoceles after radical prostatectomy. Curr Urol Rep 2015; 15:445. [PMID: 25129450 DOI: 10.1007/s11934-014-0445-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The development of a lymphocele after pelvic surgery is a well-documented complication, especially where pelvic lymph node dissection (PLND) is part of the operation. However, not all lymphoceles are symptomatic and require treatment. Most lymphoceles spontaneously resolve, and even lymphoceles that become symptomatic may resolve without any intervention. Robotic assisted radical prostatectomy (RARP) is a common operation in urology where PLND is likely to be performed in intermediate and high-risk prostate cancer patients. The rationale for performing a PLND in prostate cancer is for accurate staging and potential therapeutic benefits. However, due to potential intraoperative and postoperative complications there is still a debate regarding the value of PLND in prostate cancer. In this review, we will discuss the potential risk factors to be aware of in pelvic surgery in order to minimize the formation of a lymphocele, along with the management for clinically significant lymphoceles.
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Affiliation(s)
- Hak J Lee
- Department of Urology, UC San Diego Health Systems, 200 West Arbor Drive, # 8897, San Diego, CA, 92103, USA,
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17
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Saar M, Ohlmann CH, Janssen M, Stöckle M, Siemer S. [Radical prostatectomy. Detection and management of intra- and postoperative complications]. Urologe A 2014; 53:976-83. [PMID: 25023234 DOI: 10.1007/s00120-014-3500-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Radical prostatectomy is the most common treatment for organ-confined prostate cancer. Performed without complications and limitations, surgery will allow complete removal of the tumor and, therefore, cure the patient. Operative techniques have been improved during the last few decades to reduce invasiveness of the procedure. Furthermore, optimized perioperative management has shortened hospital stay. To ensure rapid recovery of each patient, early detection of complications is highly relevant. Herein, different scenarios for peri- and postoperative complications are described, and recommendations for best practice solutions are reviewed.
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Affiliation(s)
- M Saar
- Klink für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, Geb. 6, 66421, Homburg/Saar, Deutschland,
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18
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Hoyland K, Vasdev N, Boustead G. A rare aetiology for increased drain output following a robotic-assisted prostatectomy. BMJ Case Rep 2014; 2014:bcr-2013-201685. [PMID: 24554675 DOI: 10.1136/bcr-2013-201685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Robotic prostatectomies are being performed increasingly, with greater visualisation and improved precision, resulting in fewer postoperative complications. Despite advances in surgical techniques, drain output still remains one of the first signs of potential complications. We present the case of an iatrogenic cause for high drain output postoperatively, in order to highlight the potential problems of the drain itself. A 69-year-old man presented with a pelvic drain output of over 2 L a day as a result of the drain tip being placed at the site of the anastomosis. Here we discuss the rates of the three main causes of increased drain outputs following robotic prostatectomy, as well as highlighting the resulting complications. Overall, this case highlights the potential complications arising from the drain, which could potentially be avoided by either routine evaluation of the drain position postoperatively or by omitting the drain entirely if the anastomosis is performed well.
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Affiliation(s)
- Kimberley Hoyland
- Department of Urology, Lister Hospital, Stevenage, Hertfordshire, UK
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19
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Abstract
Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance--such as ultrasonography or MRI--to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.
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20
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Froehner M, Novotny V, Koch R, Leike S, Twelker L, Wirth MP. Perioperative Complications after Radical Prostatectomy: Open versus Robot-Assisted Laparoscopic Approach. Urol Int 2013; 90:312-315. [DOI: 10.1159/000345323] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
<b><i>Background:</i></b> The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed. In this study, we compared the complication rates of open and robot-assisted radical prostatectomy during the introduction and subsequent routine use of a da Vinci® robotic device while open surgery remained the standard approach. <b><i>Patients and Methods:</i></b> Between January 1st, 2006, and June 4th, 2012, 2,754 men underwent radical prostatectomy at our department. Among them, 317 received robot-assisted and 2,438 open surgery. According to the requirements for prostate cancer centers certified by the Deutsche Krebsgesellschaft (German Cancer Society), a prospective database recording perioperative complications was built up. The complication rates of open and robot-assisted radical prostatectomy were compared with the χ<sup>2</sup> or Fisher exact test. The distributions of quantitative variables were compared with U tests. <b><i>Results:</i></b> Whereas the demographic factors favored patients selected for robot-assisted radical prostatectomy, there were no differences between open and robot-assisted surgery concerning length of stay, autologous blood transfusion rates and the incidence of perioperative complications. <b><i>Conclusions:</i></b> Open and robot-assisted radical prostatectomy had comparable complication rates. With better patient- and tumor-related parameters as well as decreasing transfusion rates in the robot-assisted subgroup, this observation might reflect the learning curves of the involved robotic surgeons.
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