American Journal of Obstetrics and Gynecology
ResearchOncologyA randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer
Section snippets
Materials and Methods
This was an open, randomized, prospective pilot study conducted between November 2008 and July 2009 at the Gynecologic Oncology Unit of the Catholic University of the Sacred Heart in Rome. Consecutive patients who have gynecological malignancy (endometrial or cervical cancer) submitted to systematic laparoscopic PL were enrolled.
Approval from the institutional review board of the Catholic University was obtained and patients involved in the study signed a written informed consent to participate
Results
Thirty consecutive patients were enrolled in the study between November 2008 and July 2009. Clinicopathological characteristics of these patients are shown in Table 1. Median age was 45.50 years (range, 28–73 years), and median body mass index (BMI) was 25 Kg/m2 (range, 19–37). A total of 15 patients had cervical cancer and 15 patients had endometrial cancer. At the time of LPL, radical hysterectomy was performed in 19 patients, whereas, 7 patients underwent conization for early cervical
Comment
The most frequently reported postoperative complication of PL in patients with gynecologic malignancies are lymphoceles, which are clinically related to lymphedema of the lower extremity, deep venous thrombosis, and pulmonary emboli and in some cases pelvic abscess. The reported incidence of lymphoceles after PL ranges from 1% to 49%.1, 2, 3, 4, 5, 6, 7, 8, 9, 10
In literature, reported risk factors for the occurrence of lymphocysts are: the number of lymph nodes removed, the presence of
References (26)
- et al.
Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients
Am J Obstet Gynecol
(2006) - et al.
Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies
Gynecol Oncol
(2004) - et al.
Pelvic lymphocyst—a 10-year experience
Gynecol Oncol
(1988) - et al.
Management of lymphocysts after radical gynecologic surgery
Gynecol Oncol
(1989) Closed-suction drainage versus no drainage following radical abdominal hysterectomy with pelvic lymphadenectomy for stage IB cervical cancer
Gynecol Oncol
(1995)- et al.
Significant venous thromboembolism caused by pelvic lymphocysts: diagnosis and management
Gynecol Oncol
(1982) - et al.
Fibrin application for preventing lymphocysts after retroperitoneal lymphadenectomy in patients with gynecologic malignancies
Gynecol Oncol
(2002) - et al.
Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature
Gynecol Oncol
(1998) - et al.
Laparoscopic radical hysterectomy using pulsed bipolar system: comparison with conventional bipolar electrosurgery
Gynecol Oncol
(2007) - et al.
Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in endometrial cancer
Int J Gynaecol Obstet
(2006)
Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosys vascular staples and sutures for arterial and venous ligation in a porcine model
J Urol
The lymphatic drainage of the uterine cervix in adult fresh cadavers: anatomy and surgical implications
Eur J Surg Oncol
Pelvic lymphadenectomy in cervical cancer—surgical anatomy and proposal for a new classification system
Gynecol Oncol
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Reprints not available from the authors.
Cite this article as: Gallotta V, Fanfani F, Rossitto C, et al. A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer. Am J Obstet Gynecol 2010;203:483.e1-6.