Laparoscopic lymphocelectomy: A multi-institutional analysis

Purpose: Because symptomatic lymphoceles are infrequent, single center stud ies generally report small numbers of patients. We report a multi-instituti onal experience with and long-term outcome following laparoscopic lymphocel ectomy in 81 patients. Materials and Methods: Data were obtained from 9 institutions at which at l east 5 cases of laparoscopic lymphocelectomy had been performed. Baseline p atient demographics, operative time and blood loss, special operative adjun ct techniques, postoperative course, convalescence, complications and lymph ocele recurrence data were collected and analyzed. Results: A total of 56 men and 25 women with a mean age of 41 years were in cluded in the study. Lymphocele formed after renal transplantation in 78 pa tients (96%) and after pelvic lymph node dissection in 3 (4%). Average oper ating time was 123 minutes with a mean blood loss of 43 ml. Omentopexy was performed in 11 cases (13.6%). No intraoperative stenting of the transplant ureter was performed. Intraoperative complications consisted of laryngospa sm, bladder injury, inferior epigastric artery injury and mild renal capsul e hematoma in 1 patient each. Conversion to open surgery was required for r epair of bladder injury in 1, repair of preexisting hernia in 1, unusually thickened lymphocele wall in 1 and inaccessible lymphocele location in 4 ca ses. Mean time to ambulation and resumption of regular diet was 1 day, and mean hospital stay was 1.5 days. Postoperative complications included troca r site hernia in 1 and urinary retention in 2. Convalescence averaged 2.5 w eeks. During a mean followup of 27 months 5 patients (6%) had lymphocele re currence. Conclusions: Laparoscopic lymphocelectomy is safe, minimally invasive and e ffective. It is an excellent alternative to the conventional open surgical approach.