Harland Niklas, Alfarra Mohammed, Erne Eva, Maas Moritz, Amend Bastian, Bedke Jens, Stenzl Arnulf
Department of Urology, Medical Faculty and University Hospital, Eberhard-Karls-University Tuebingen, 72076 Tuebingen, Germany.
J Clin Med. 2023 Jan 19;12(3):791. doi: 10.3390/jcm12030791.
The retzius-sparing approach for robotic-assisted radical prostatectomy (RARP) has been increasingly adopted. Symptomatic lymphoceles are a widespread complication of RARP with pelvic lymph node dissection. Here, we present a new technique, the peritoneal purse-string suture (PPSS), that seems to reduce the rate of symptomatic lymphoceles following retzius-sparing RARP with extended pelvic lymph node dissection (ePLND).
The radical prostatectomy and bilateral lymphadenectomy are performed through three separate peritoneal openings. The PPSS uses a single suture in a way similar to a purse-string suture; the openings of both lymphadenectomy fields are widened, and the rectovesical opening from the prostatectomy is simultaneously closed. This report retrospectively evaluates the perioperative and postoperative outcomes of two consecutive patient cohorts undergoing RARP with ePLND by a single surgeon between May 2015 and June 2019, one cohort prior to introducing PPSS as control ( = 145) and the other after introducing PPSS ( = 91).
The two study groups were comparable on baseline characteristics, except ASA. There were no Clavien-Dindo grade IV-V complications, and comparable rates of grade I-III complications. The difference in postoperative lymphocele formation was 22% in PPSS versus 27% in the control group ( = 0.33). The rate of symptomatic lymphoceles was significantly lower in the PPSS group (3% vs. 10%, = 0.047).
The PPSS is a feasible procedure that reduces symptomatic lymphoceles in patients undergoing RARP with a retzius-sparing approach.
保留Retzius间隙的机器人辅助根治性前列腺切除术（RARP）已被越来越多地采用。有症状的淋巴囊肿是RARP联合盆腔淋巴结清扫术后常见的并发症。在此，我们介绍一种新技术，即腹膜荷包缝合术（PPSS），该技术似乎能降低保留Retzius间隙的RARP联合扩大盆腔淋巴结清扫术（ePLND）后有症状淋巴囊肿的发生率。
根治性前列腺切除术和双侧淋巴结清扫术通过三个独立的腹膜开口进行。PPSS使用单根缝线，方式类似于荷包缝合；扩大双侧淋巴结清扫区域的开口，同时关闭前列腺切除术后的直肠膀胱开口。本报告回顾性评估了2015年5月至2019年6月期间由同一位外科医生为两组连续患者实施ePLND的RARP手术的围手术期和术后结果，一组在引入PPSS之前作为对照组（n = 145），另一组在引入PPSS之后（n = 91）。
除美国麻醉医师协会（ASA）分级外，两个研究组的基线特征具有可比性。未出现Clavien-Dindo IV-V级并发症，I-III级并发症发生率相当。PPSS组术后淋巴囊肿形成率为22%，对照组为27%（P = 0.33）。PPSS组有症状淋巴囊肿的发生率显著更低（3%对10%，P = 0.047）。
PPSS是一种可行的手术方法，可降低采用保留Retzius间隙方法进行RARP手术患者有症状淋巴囊肿的发生率。
