Complications after laparoscopic pelvic lymphadenectomy: CT diagnosis.
OBJECTIVE
Laparoscopic dissection of pelvic lymph nodes has become an accepted alternative to open lymphadenectomy for staging of genitourinary tumors. This study reviews the CT findings in patients with major complications detected after laparoscopic dissection.


METHODS
Of 85 patients who had laparoscopic dissection of pelvic lymph nodes at our institutions during a 3-year period, complications developed in 12 patients (14%), and eight of these had abdominopelvic CT studies done. CT findings and initial interpretations were correlated with follow-up surgical, clinical, or interventional radiologic findings in all cases.


RESULTS
Complications of laparoscopic dissection detected with CT included small-bowel obstruction due to herniation through the trocar site in the abdominal wall (n = 2), extensive hematoma of the abdominal wall or retroperitoneum (n = 2), urinary ascites or multiple urinomas due to ureteral laceration or transection (n = 2), and lymphocele compressing the bladder where the peritoneum was sealed after lymphadenectomy (n = 1). In one case, CT showed pneumoperitoneum but failed to show a perforation of the sigmoid colon.


CONCLUSIONS
Major complications occurred after laparoscopic dissection of pelvic lymph nodes and were diagnosed on the basis of CT findings in seven of eight patients. Recognition of the CT appearances of hernia or hematoma at the insertion sites of the trocars or the laparoscope is important, as is detection of injury to bladder, ureter, bowel, or blood vessels. Symptomatic lymphoceles were infrequently detected, probably because of the use of free drainage into the peritoneal cavity after laparoscopic dissection.
Department of Radiology, University of Maryland School of Medicine, Baltimore 21201.
C C
CC
Chow
B D
BD
Daly
T L
TL
Burney
T L
TL
Krebs
K
K
Grumbach
P S
PS
Filderman
S C
SC
Jacobs
D000368:Aged; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009367:Neoplasm Staging; D010388:Pelvis; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014565:Urogenital Neoplasms / Q000473:pathology; D014570:Urologic Diseases / Q000000981:diagnostic imaging / Q000209:etiology