title: Rapid excision of massive localized lymphedema of the male genitalia with vessel sealing device.
abstract: BACKGROUND
  To present a series of patients who underwent surgical treatment for massive localized lymphedema (MLL) of the male genitalia and explore the utility of the LigaSure hemostatic vessel sealing device (VSD) for resection of advanced cases.
  
  
  METHODS
  Although conservative and microsurgical treatments have been reported, MLL of the male genitalia requires open surgical resection with primary reconstruction. We reviewed our prospectively maintained database of all lymphedema excisions performed between January 2007 and December 2014 comparing resection with Bovie electrocautery to resection with the LigaSure VSD. Our analysis focused on any significant differences in rate of resection, estimated blood loss (EBL), and recurrence.
  
  
  RESULTS
  Nineteen patients with MLL of the male genitalia underwent excision with either LigaSure (8 patients) or conventional Bovie electrocautery (11 patients). Rate of resection was significantly faster with LigaSure compared to Bovie (33.74 g/min versus 5.32 g/min, p = .035). Additionally, estimated EBL per gram of tissue resected was decreased in the LigaSure group (0.41 mL/g versus 0.17 mL/g, p = .057). Two of the 11 Bovie patients (18%) had recurrence of lymphedema requiring repeat resection, while none of the LigaSure patients developed recurrence.
  
  
  CONCLUSIONS
  Resection of genital lymphedema using the LigaSure device offers promising results in managing advanced MLL of the male genitalia with the potential for faster resections, less EBL per tissue resected, and a lower rate of recurrence.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Siegel
authors.forename: Lee
authors.initials: L
authors.lastname: Zhao
authors.forename: Isamu
authors.initials: I
authors.lastname: Tachibana
authors.forename: Scott
authors.initials: S
authors.lastname: Carlson
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Klein
authors.forename: Alex
authors.initials: A
authors.lastname: Vanni
authors.forename: Thomas
authors.initials: T
authors.lastname: Rozanski
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D016063:Blood Loss, Surgical; D004564:Electrocoagulation; D006801:Humans; D008209:Lymphedema / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D061646:Operative Time; D010413:Penis / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery*; D016038:Skin Transplantation; D013519:Urogenital Surgical Procedures / Q000295:instrumentation / Q000379:methods*