The use of Enseal technology can prevent the formation of lymphoceles in course of radical prostatectomy?

Objective

The objective of this study is to evaluate the effectiveness of the Ethicon Enseal G2 25mm curved technology in the prevention of lymphocele after pelvic lymphadenectomy after open radical prostatectomy .
METHODS: From January 2011 to December 2013 122 consecutive patients who underwent pelvic lymphonode excision during open radical prostatectomy  with the use of Ethicon ENSEAL G2 Tissue Sealer , 25cm , all performed by the same operator. 107 followed up for at least 6 month. Patients were followed with ETG abdominal examination at 1 week, 3 week,1,3 and 6 months after surgery in order to assess the presence of even asymptomatic lymphocele

Methods and results

RESULTS:
The medium number of lymph nodes removed was 12 (range 6-16 ) . The median preoperative PSA was 6.5 ng/ml (range 4-29 ) . The median Gleason score was 7 (range 6-9) .In 3 patients lymphonode metastases were found on histologic examination. 6 patients (4.9% ) develop lymphocele.1 patient develop lynphocele 1 week after surgery 3 patients at 3 weeks 2 cases at 1 month . In 3 of these the lymphocele was less than 80 cc and all the 3 patients were asymptomatic and it wasn't necessary to perform other procedure.1 patient present a bilateral linphocele. 2 patients were subjected to percoutaneous evacuative puncture and 1 was subjected to lymphocele marsupialization.

Discussion

DISCUSSION:
The results obtained in our patients treated with the use of technology En Seal were compared our data with the litterature performed with Bipolar forceps .We found a statistically significant correlation between the use of technology En Seal and the decrease in the number of lymphoceles occurred.
CONCLUSIONS:
The occurrence of postoperative lymphocele is one of the most frequent complications in course of radical prostatectomy. The use of Enseal ,on the basis of our data, decreases the incidence of lymphocele due to its action on the sealing lymphatics .An important role , in our opinion, seems to be done by PTC that decreasing the lateral thermal damage and preventing the increase of the temperature inside the branches above 100 ° C . That prevents the processes of carbonization of the tissues and the subsequent laceration of lymphatic endothelium that may be responsible for this lated complication .

References

Influence of body mass index, surgical approach and lymphadenectomy on the development of symptomatic lymphoceles after radical prostatectomy.
Mundhenk J, Hennenlotter J, Alloussi S, Selbherr D, Martzog JC, Todenhöfer T, Kruck S, Schwentner C, Stenzl A, Schilling D.
Urol Int. 2013;90(3):270-6.

Complications of pelvic lymph node dissection for prostate cancer.
Keegan KA, Cookson MS.
Curr Urol Rep. 2011 Jun;12(3):203-8.

Risk factors for pelvic lymphoceles post-radical prostatectomy.
Khoder WY, Trottmann M, Buchner A, Stuber A, Hoffmann S, Stief CG, Becker AJ.
Int J Urol. 2011 Sep;18(9):638-43.

Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection.
Gotto GT, Yunis LH, Guillonneau B, Touijer K, Eastham JA, Scardino PT, Rabbani F.
Int J Urol. 2011 Feb 10.

Predictors of symptomatic lymphocele after lymphonode excision and radical prostatectomy.
Naselli A, Andreatta R,Introini C, Fontana V, Puppo P.
Urology. 2010 Mar;75(3):630-5

How can lymphocele development be prevent after laparoscopic radical prostatectomy?
Yasumizu Y, Miyajima A, Maeda T, Takeda T, Hasegawa M, Kosaka T, Kikuchi E, Oya M.
J Endourol. 2013 Apr;27(4):447-51