title: Prevention of lymphoceles using FloSeal and CoSeal after laparoscopic lymphadenectomy in patients with gynecologic malignancies.
abstract: BACKGROUND
  Pelvic ± para-aortic lymphadenectomy (LAE) is an essential element of staging and treatment of different gynecologic malignancies. However, LAE can induce asymptomatic and symptomatic pelvic lymphoceles (LCs) in a considerable percentage of patients. Therapy of symptomatic LCs may cause additional morbidity. The best strategy to reduce the rate of LCs has not established yet.
  
  
  METHODS
  Between January 2011 and May 2012, transperitoneal laparoscopic pelvic ± para-aortic LAE was performed at the Department of Gynecology at Charité University Hospital Berlin in 238 patients with cervical, endometrial, ovarian, or groin-positive vulvar cancer. The application of FloSeal (Baxter, Deerfield, IL) and CoSeal (Baxter) was used in 25 patients (group A) as an alternative to routine pelvic drainage after LAE. A case-control comparison was performed on 25 patients (group B) with bilateral drainage after complete LAE. The primary objective of this pilot study was to evaluate the feasibility and safety of the method. As a secondary objective, we evaluated the incidence of LCs and symptomatic LCs in both groups. The detection of LCs was performed during oncologic follow-up by sonography, computed tomographic imaging, or magnetic resonance imaging.
  
  
  RESULTS
  Pelvic (n = 50) or pelvic + para-aortic (n = 42) LAE was performed in 44 patients with cervical, 2 with endometrial, 1 with ovarian, and 2 with groin-positive vulvar cancer, respectively. In group B (n = 25), systematic bilateral pelvic drainage was placed after finishing LAE, whereas in group A (n = 25) LAE areas were sealed with 5 mL FloSeal on each side and sprayed with CoSeal afterward without placing drains. In 14 of 50 patients (28%), LCs were detected. In a subgroup of patients with cervical cancer (88% of the cohort), symptomatic LCs occurred in 11% in group A and 18% in group B. Operative revision of symptomatic LCs was necessary in 5% and 18% in groups A and B, respectively (p = .66). Mean Hospital stay was significant shorter in group A (6 days) versus B (8 days) (p = .027).
  
  
  CONCLUSIONS
  The results of this case-controlled pilot study indicate that the application of FloSeal and CoSeal after transperitoneal LAE is feasible and safe, may reduce hospital stay, and may potentially decrease the rate of symptomatic LCs in patients with gynecologic malignancies.
authors.affiliation: Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany.
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
authors.affiliation: Department of Gynecology, Charité Universitt of Gynec, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kyeyamwa
authors.affiliation: Department of Radiooncology, Charité Universitt of Radio, Berlin, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Marnitz
authors.affiliation: Department of Gynecologic Oncology, Cancer Centre Barretos, Barretos, Brazil.
authors.forename: Audrey
authors.initials: A
authors.lastname: Tsunoda
authors.affiliation: Department of Gynecology, Charité Universitt of Gynec, Berlin, Germany.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Vercelino
authors.affiliation: Institute for Cytologie and Dyplasia, Füytologie and Dyp, Berlin, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany. Electronic address: gdifavero@hotmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Favero
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008210:Lymphocele / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D010865:Pilot Projects; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control
chemical_list: C513322:CoSeal; C411004:FloSeal Matrix; D011092:Polyethylene Glycols
keywords: Gynecologic malignancies; Laparoscopic lymphadenectomy; Prevention of lymphoceles