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Prevention of lymphorrhea in aortic lymphadenectomy
  1. Mikel Gorostidi1,
  2. Cecilia Villalain2,
  3. Ruben Ruiz1,
  4. Ibon Jaunarena1,
  5. Paloma Cobas1 and
  6. Arantza Lekuona1
  1. 1 Hospital Universitario Donostia, San Sebastian, Spain
  2. 2 Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
  1. Correspondence to Dr Mikel Gorostidi, Hospital Universitario Donostia, San Sebastian 20002, Spain; mgorostidi{at}


The objective of this video 1 is to describe the technique to avoid postoperative lymphorrhea after a lumboaortic lymphadenectomy. All procedures were performed at Donostia University Hospital, a tertiary referral and educational center in San Sebastián, Spain. Lumboaortic extra-peritoneal lymphadenectomy was performed for several gynecological malignancies (endometrial and cervical cancer). During the procedure, afferent lymphatic capillaries were identified at the infra-renal aortic level and clipped to avoid retrograde lymphorrhea at this level. Numerous strategies have been described to reduce the likelihood of lymphorea and lymphocele formation.1 Harmonic scalpel and other sealing advanced devices are not useful to secure lymphatic leakage at this level, although some authors have published a clinical benefit in their use,2 while clips have been found useful to prevent leakage in other lymphatic locations.3 The use of harmonic scalpel, biological agents or surgical patch has been ineffective in our experience, but sealing clips and peritonization (marsupialization),4 once the procedure is concluded, could be an effective approach. Performing simple gestures during lumboaortic lymphadenectomy can help to reduce the appearance of posterior lymphorrhea.

  • laparoscopy
  • lymphadenectomy
  • lymphorrhea
  • lumboaortic lymphadenectomy
  • retroperitoneal laparoscopy
  • vessel-sealing device
  • clip

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Video 1.


I will like to acknowledge the support of all my team, my patients and their families.


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  • Contributors MG: conception, design of the study, interpretation, responsible surgeon, manuscript preparation and video editing. CV: Manuscript and video preparation, narration. RR: Surgeon. IJ : Surgeon. PC: Patient recruitment. AL: Patient recruitment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Local IRB (Institutional Review Board) was consulted, this article being exempt from the need for approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.