Research
Oncology
A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer

https://doi.org/10.1016/j.ajog.2010.06.053Get rights and content

Objective

This prospective randomized pilot study compared the use of the Ligaclip (Ethicon Endo-Surgery, Cincinnati, OH) with bipolar coagulation in preventing lymphoceles after laparoscopic pelvic lymphadenectomy for gynecologic cancer.

Study Design

Thirty patients with gynecologic malignancy, who had laparoscopic pelvic lymphadenectomy were randomly assigned for lymphadenectomy in 1 side of the pelvis using the Ligaclip, whereas, in the other side, the bipolar coagulation to seal lymphatic vessels was used.

Results

At ultrasound examination, we detected lymphocele in 10 patients (33%). Lymphocele developed in 9 (30%) patients on the side where laparoscopic pelvic lymphadenectomy was perfomed using bipolar coagulation, and in 1 (3.3%) patient on the side where laparoscopic pelvic lymphadenectomy was performed using the Ligaclip. Univariate analysis revealed that the Ligaclip's use compared with electrocoagulation in the laparoscopic pelvic lymphadenectomy is an independent predictive factor for development of lymphocele (P = .006).

Conclusion

This study demonstrates that the use of the Ligaclip to close lymphatic vessels may reduce the incidence of lymphoceles in patients undergoing laparoscopic pelvic lymphadenectomy.

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)

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    Another study showed a reduction in significant lymphoceles after laparoscopic PLND using a vessel-sealing device (6.7 % vs 26.6%).16,17 Surgical clips have also been suggested as superior to bipolar electrocautery alone.6,7 Whether a transperitoneal procedure offers protection is unclear, as demonstrated by Orvieto et al who had a 51% lymphocele rate following transperitoneal robotic prostatectomy and PLND in 76 patients despite performing only limited node dissections.15

  • Prevention of Lymphoceles Using FloSeal and CoSeal After Laparoscopic Lymphadenectomy in Patients With Gynecologic Malignancies

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    Therefore, our rate of asymptomatic and symptomatic LCs meets this spectrum. Although therapy for symptomatic LCs is established by puncture (with or without installation of ethanol, tetracycline, doxycycline, bleomycin, or povidone-iodine) or reoperation with fenestration of LCs with success rates between 90% and 100%, the best method for prevention is not established yet [14,15,27–31]. There are different risk factors for the occurrence of LCs that are controversially discussed in the literature.

  • Does ultrasonic advanced energy reduce lymphocele incidence in laparoscopic para-aortic lymphadenectomy?

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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.

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