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Lymphocele Prevention After Pelvic Laparoscopic Lymphadenectomy by a Collagen Patch Coated With Human Coagulation Factors: A Matched Case-Control Study
  1. Andrea Tinelli, MD*,
  2. Ospan A. Mynbaev, MD, PhD,
  3. Daniel Alberto Tsin, MD, PhD,
  4. Giorgio Giorda, MD§,
  5. Antonio Malvasi, MD,
  6. Marcello Guido, PhD and
  7. Farr R. Nezhat, MD, PhD
  1. *Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy;
  2. The Experimental Researches & Modeling Division, Moscow State University of Medicine & Dentistry and The Department of Obstetrics, Gynecology & Reproductive Medicine, Peoples’ Friendship University of Russia, Moscow, Russia;
  3. Divisionof Minimal Invasive Endoscopy, Department of Gynecology, TheMount Sinai Hospital, Queens, NY;
  4. §Division of Gynecologic Oncology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Italy;
  5. Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy;
  6. Laboratory of Hygiene, Department ofBiological and Environmental Sciences and Technologies, Di.S.Te.B.A., Faculty of Sciences, University of Salento, Lecce, Italy;and
  7. #Columbia University College of Physicians and Surgeons, New York, NY; and Division of Gynecologic Oncology and the Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, NY.
  1. Address correspondence and reprint requests to Andrea Tinelli, MD, Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy. E-mail: andreatinelli@gmail.com.

Abstract

Objective Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy.

Materials and Methods The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration.

Results The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request.

Conclusions In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

  • Lymphocele
  • Endometrial cancer
  • Pelvic lymphadenectomy
  • TachoSil
  • Lymph nodes
  • Radical hysterectomy
  • Lymphocysts
  • Drainage
  • Complications

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Footnotes

  • The authors declare no conflicts of interest.

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