title: Does ultrasonic advanced energy reduce lymphocele incidence in laparoscopic para-aortic lymphadenectomy?
abstract: OBJECTIVE
  To evaluate the use of ultrasonic advanced energy in reducing the occurrence of symptomatic lymphocele and its related complications in laparoscopic extra-peritoneal para-aortic lymphadenectomy in patients with gynecological cancer.
  
  
  METHODS
  A retrospective cohort study of consecutive patients in a tertiary referral center identified 2 groups of patients, undergoing laparoscopic extra-peritoneal para-aortic lymphadenectomy with or without the use of ultrasonic advanced energy. Surgery time, hospital stay, number of retrieved nodes and lymphocele requiring treatment were studied. Results were also compared between trained and trainee surgeons.
  
  
  RESULTS
  163 patients were scheduled for laparoscopic extra-peritoneal para-aortic lymphadenectomy: 81 treated using bipolar energy (control group: group 1) between August 1999 and January 2005, and 82 treated using ultrasonic advanced energy (study group: group 2) between July 2010 and March 2014. The main indication (90% in group 1, 61% in group 2) was advanced cervical carcinoma (stage IB2 and above). Ultrasonic advanced energy significantly decreased operative time (p=0.001) and intra-operative bleeding (p=0.01) and increased the number of para-aortic nodes retrieved (p=0.02). There was no significant difference in hospital stay or lymphocele requiring treatment (8.6% in group 1, 8.5% in group 2: p=0.98). For senior than for junior surgeons, surgery time was shorter but not significantly (p=0.80) and postoperative lymphocele rates were identical.
  
  
  CONCLUSIONS
  Ultrasonic advanced energy may provide benefit in laparoscopic para-aortic lymphadenectomy, facilitating surgical ergonomics, but did not decrease post-surgery lymphocele.
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France. Electronic address: gery.lamblin@chu-lyon.fr.
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Lauriane
authors.initials: L
authors.lastname: Chauvy
authors.affiliation: Department of Radiology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Rannou
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Mathevet
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chabert
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Mellier
authors.affiliation: Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008210:Lymphocele / Q000209:etiology*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data
keywords: Laparoscopic para-aortic lymphadenectomy; Lymphocele; Ultrasonic advanced energy