Journal article
Peritoneal Window Technique: A Novel Sutureless Technique to Decrease the Rate of Symptomatic Lymphocele after Robot-Assisted Radical Prostatectomy with Extended Pelvic Lymph Node Dissection
Journal of endourology, Vol.39(10), pp.1028-1032
10/2025
DOI: 10.1089/end.2025.0093
PMID: 40491420
Abstract
Introduction: Robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (PLND) represents the gold standard surgical treatment for high-risk localized prostate cancer. PLND carries the risk of lymphocele formation, which can lead to complications such as deep vein thrombosis (DVT), infection, and voiding dysfunction. Many techniques have been described to minimize lymphocele formation, yet no method has seen widespread use or been described as sutureless. The objective of this study is to describe the novel, sutureless peritoneal window (PWIN) technique and assess its efficacy in lymphocele prophylaxis for extended PLND.Methods: This was a retrospective review of patients with high-risk prostate cancer undergoing RARP with extended PLND by a single surgeon from 2018 to 2024. PLND was carried out in the usual manner with bipolar cautery. PWIN technique is performed by excising a 3 x 5 cm PWIN over the lymphadenectomy bed to maintain lymphatic communication with the abdominal cavity. The primary outcome was a comparison between the incidence of symptomatic lymphoceles (SLs) with PWIN vs standard technique. SLs were defined as lymphoceles presenting with pain, DVT, voiding dysfunction, or infectious symptoms. Patients with asymptomatic lymphoceles were excluded.Results: Our study included 199 patients who underwent RARP with extended PLND. There were 46 patients (23.1%) in the standard approach group and 153 patients (76.9%) in the PWIN group. We identified 5/46 (10.9%) SLs in the standard technique, which were significantly higher than the 3/153 (2.0%) observed in the PWIN group (p = 0.017). There was no difference between the standard and PWIN cohorts regarding symptomology or treatment of their lymphocele.Conclusion: This study describes a novel, sutureless PWIN technique that significantly decreases SL after extended PLND. This technique offers a practical, time-efficient, and cost-effective alternative for lymphocele prevention. Future prospective studies are warranted to validate these findings.
Details
- Title: Subtitle
- Peritoneal Window Technique: A Novel Sutureless Technique to Decrease the Rate of Symptomatic Lymphocele after Robot-Assisted Radical Prostatectomy with Extended Pelvic Lymph Node Dissection
- Creators
- Eric Qualkenbush - Mayo Clinic in FloridaYeonsoo S. Lee - Mayo Clinic in FloridaAmanda Kahn - Mayo Clinic in FloridaNeda Qosja - Mayo Clinic in FloridaAlex Hochwald - Mayo Clinic in FloridaAmanda Myers - The University of Texas MD Anderson Cancer CenterAndrew Zganjar - Mayo Clinic in FloridaRam Pathak - Mayo Clinic in FloridaRaymond Pak - Mayo Clinic in Florida
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.39(10), pp.1028-1032
- DOI
- 10.1089/end.2025.0093
- PMID
- 40491420
- NLM abbreviation
- J Endourol
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Publisher
- Mary Ann Liebert, Inc
- Number of pages
- 5
- Language
- English
- Electronic publication date
- 06/10/2025
- Date published
- 10/2025
- Academic Unit
- Urology
- Record Identifier
- 9984934816202771
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