Prevention of lymphorrhea in aortic lymphadenectomy. Issue 3 (4th March 2019)

• Record Type: Journal Article
• Authors: Gorostidi, Mikel; Villalain, Cecilia; Ruiz, Ruben; Jaunarena, Ibon; Cobas, Paloma; Lekuona, Arantza
• Is Part Of: International journal of gynecological cancer. Volume 29:Issue 3(2019)
• Page Start: 645
• Page End: 646
• Publication Date: 2019-03-04
• Subjects: laparoscopy -- lymphadenectomy -- lymphorrhea -- lumboaortic lymphadenectomy -- retroperitoneal laparoscopy -- vessel-sealing device -- clip; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2018-000128
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : The objective of this video 1 is to describe the technique to avoid postoperative lymphorrhea after a lumboaortic lymphadenectomy. All procedures were performed at Donostia University Hospital, a tertiary referral and educational center in San Sebastián, Spain. Lumboaortic extra-peritoneal lymphadenectomy was performed for several gynecological malignancies (endometrial and cervical cancer). During the procedure, afferent lymphatic capillaries were identified at the infra-renal aortic level and clipped to avoid retrograde lymphorrhea at this level. Numerous strategies have been described to reduce the likelihood of lymphorea and lymphocele formation.1 Harmonic scalpel and other sealing advanced devices are not useful to secure lymphatic leakage at this level, although some authors have published a clinical benefit in their use, 2 while clips have been found useful to prevent leakage in other lymphatic locations.3 The use of harmonic scalpel, biological agents or surgical patch has been ineffective in our experience, but sealing clips and peritonization (marsupialization), 4 once the procedure is concluded, could be an effective approach. Performing simple gestures during lumboaortic lymphadenectomy can help to reduce the appearance of posterior lymphorrhea.