title: Prospective Randomized Trial Comparing Titanium Clips to Bipolar Coagulation in Sealing Lymphatic Vessels During Pelvic Lymph Node Dissection at the Time of Robot-assisted Radical Prostatectomy.
abstract: Lymphocele is the most common complication after pelvic lymph node dissection (PLND). Over the years, various techniques have been introduced to prevent lymphocele, but no final conclusion can be drawn regarding the superiority of one technique over another. In this prospective study, 220 patients undergoing robot-assisted radical prostatectomy between 2012 and 2015 were randomized to receive titanium clips (group A, n=110) or bipolar coagulation (group B, n=110) to seal lymphatic vessels at the level of the femoral canal during extended PLND (ePLND). Ultrasound examination was used to detect lymphoceles at 10 and 90 d after surgery. Lymphocele was defined as any clearly definable fluid collection and was considered clinically significant when requiring treatment. There were no statistically significant differences between groups A and B regarding overall lymphocele incidence (47% vs 48%; difference -0.91%, 95% confidence interval [CI] -2.6 to 0.7; p=0.9) and the rate of clinically significant lymphocele [5% vs 4%; difference 0.75%, 95% CI, 0.1-3.2; p=0.7]. The two groups were comparable regarding mean (±SD) lymphocele volume (30±32 vs 35±39ml; p=0.6), lymphocele location (unilateral, 37% vs 35%, p=0.7; bilateral, 13% vs 14%, p=0.9), and time to lymphocele diagnosis (95% vs 98% on postoperative day 10; p=0.5). In conclusion, this trial failed to identify a difference in lymphocele occurrence between clipping and coagulation of the lymphatic vessels at the level of the femoral canal during robot-assisted ePLND for prostate cancer.
  
  
  
  In this study we compared the frequency of postoperative complications after sealing lymphatic vessels from the leg to the abdomen using metallic clips or electrical coagulation during robot-assisted surgery for prostate cancer. We found no difference in postoperative complications between the two methods.
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Grande
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Di Pierro
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Livio
authors.initials: L
authors.lastname: Mordasini
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Würnschimmel
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Danuser
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: agostino.mattei@luks.ch.
authors.forename: Agostino
authors.initials: A
authors.lastname: Mattei
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D004564:Electrocoagulation; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation* / Q000379:methods; D042601:Lymphatic Vessels / Q000601:surgery*; D008210:Lymphocele / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures; D013525:Surgical Instruments; D014025:Titanium
chemical_list: D001672:Biocompatible Materials; D014025:Titanium
keywords: Complications; Lymph node dissection; Lymphocele; Prostate cancer; Robot-assisted