Mathew Jeni Elizabeth, Sodhi Bikramjit Singh, Kaddu Deepak, Boppanna Venkata Bhargava, Ramaprasad M K, Prabhakaran Sandeep, Kishore Thekke Adiyat
Department of Urology, Aster Medcity, Kochi, Kerala, India.
Saudi J Med Med Sci. 2024 Jul-Sep;12(3):230-235. doi: 10.4103/sjmms.sjmms_634_23. Epub 2024 Jun 20.
In Retzius-sparing robot-assisted radical prostatectomy (RARP), lymphocele formation is a troublesome complication. The use of peritoneal flaps has emerged as a promising novel technique to tackle this complication. We explored this technique by suturing both the medial peritoneal flaps to each other and keeping them distracted so that the lymphadenectomy beds are left wide open.
To assess the efficacy of our peritoneal distraction technique on lymphocele rates following Retzius-sparing RARP.
This retrospective study included patients with localized prostate carcinoma who underwent Retzius-sparing RARP with standard pelvic lymph node dissection between May 2014 and September 2022 at Aster Medcity, Kochi, India. Based on the use of the technique, patients were divided into two groups: peritoneal distraction and closed groups. Both groups were matched using the propensity scoring method in a 1:1 ratio.
A total of 272 patients were included, of which 89 (32.7%) belonged to the peritoneal distraction group. Although the overall incidence of lymphocele between the two groups were comparable, none of the patients in the peritoneal distraction group required any intervention for lymphocele management, as opposed to 7 patients from the closed group (3.9%; = 0.015). No significant association was found between lymphocele formation and serum prostate-specific antigen level, Gleason score, and the number of lymph nodes harvested.
This study found that peritoneal distraction stitch is a simple and effective technique to reduce the incidence of symptomatic lymphocele that require intervention after Retzius-sparing RARP.
在保留Retzius间隙的机器人辅助根治性前列腺切除术（RARP）中，淋巴囊肿形成是一个棘手的并发症。使用腹膜瓣已成为解决这一并发症的一种有前景的新技术。我们通过将内侧腹膜瓣相互缝合并使其保持分离，从而使淋巴结清扫床敞开，对该技术进行了探索。
评估我们的腹膜分离技术对保留Retzius间隙的RARP术后淋巴囊肿发生率的疗效。
这项回顾性研究纳入了2014年5月至2022年9月在印度科钦阿斯特医学城接受保留Retzius间隙的RARP及标准盆腔淋巴结清扫术的局限性前列腺癌患者。根据该技术的使用情况，患者分为两组：腹膜分离组和闭合组。两组采用倾向评分法以1:1的比例进行匹配。
共纳入272例患者，其中89例（32.7%）属于腹膜分离组。虽然两组之间淋巴囊肿的总体发生率相当，但腹膜分离组没有患者需要对淋巴囊肿进行任何干预，而闭合组有7例患者（3.9%；P = 0.015）需要干预。未发现淋巴囊肿形成与血清前列腺特异性抗原水平、Gleason评分及清扫淋巴结数量之间存在显著关联。
本研究发现，腹膜分离缝合是一种简单有效的技术，可降低保留Retzius间隙的RARP术后需要干预的有症状淋巴囊肿的发生率。
