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The Incidence And Contemporary Management Of Symptomatic Lymphoceles After Robotic-Assisted Extraperitoneal Laparoscopic Radical Prostatectomy And Pelvic Lymph Node Dissection
Thomas Hoang, MD, Satya Allaparthi, MRCS,MD, Ingolf A. Tuerk, MD,PhD.
Caritas St Elizabeth Hospital, Boston, MA, USA.

BACKGROUND:
To better delineate the problem in our experience, we reviewed the incidence and management of symptomatic post-operative lymphoceles after robotic-assisted extraperitoneal laparoscopic radical prostatectomy(RAELP) with either unilateral or bilateral pelvic lymph node dissections performed by a single surgeon.
METHODS:
We retrospectively reviewed all RAELP by a single surgeon (IT) from November 2008 to November 2009. We identified the surgeries where a pelvic lymph node dissection was done either unilaterally or bilaterally. We then identified the number of symptomatic post-operative lymphoceles as diagnosed by a CT scan of the pelvis. Finally, we analyzed the management of these lymphoceles.
RESULTS:
We reviewed 250 RAELP as performed by a single surgeon. We found 129 (51.6%) of these surgeries involved unilateral or bilateral pelvic lymph node dissections. Sixty- eight (52.7%) of these were bilateral dissections. Twenty-four (18.6%) were left sided pelvic lymph node dissections. Thirty-seven (28.7%) were right sided pelvic lymph node dissections. Overall 12 (9.3%) lymphoceles were diagnosed out of 129 lymph node dissections. Five (42%) of these were managed conservatively with observation and repeat CT scans. Five (42%) required percutaneous drainage by interventional radiology. And two (16%) elected to undergo robotic-assisted laparoscopic bilateral lymphocelectomy. Overall 58% of symptomatic lymphoceles required intervention and all patients had a successful outcome.
CONCLUSIONS: The many advantages of the extraperitoneal approach to robotic-assisted laparoscopic radical prostatectomy have been elucidated. The disadvantages of this technique have not been thoroughly examined, including symptomatic post-operative lymphoceles. We have demonstrated that there is a significant incidence (9.3%) when performed in large numbers. These can be managed successfully in most cases with observation or percutaneous drainage /aspiration. Efforts to further decrease the incidence will be examined in a prospective study. Overall we feel the advantages of RAELP for the patient outweighs the increased risk of symptomatic lymphoceles.


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