Evaluation of Absorbable Hemostatic Powder for Prevention of Lymphoceles Following Robotic Prostatectomy With Lymphadenectomy.
OBJECTIVE
To determine whether lymphoceles can be prevented after robotic prostatectomy with pelvic lymph node dissection (PLND), we performed a prospective randomized study using an absorbable hemostatic agent (Arista AH). The most common complications of PLND for prostate cancer are related to lymphocele formation, which occur in 30%-50% of patients according to studies that performed screening imaging. Although most are asymptomatic, when intervention is required the cost and morbidity are high.


METHODS
Of 100 patients enrolled, 88 completed the study. Each patient served as his or her own control, with Arista AH placed over the field of PLND on only one side in a randomized fashion as revealed only after bilateral PLND was completed. All patients underwent screening pelvic computed tomography scan 3 months later, with radiologists blinded to the Arista AH treated side. A significant lymphocele was defined as a fluid collection 3 cm or greater in any plane.


RESULTS
The mean lymph node yield was 8.1 nodes. Fourteen lymphoceles were identified. Five occurred on the side where Arista AH was used vs 9 on untreated sides (5.7% vs 10.2%, P = .248). When they occurred, there was no statistically significant difference in lymphocele size between treated and untreated sides (P = .441). No lymphoceles were symptomatic.


CONCLUSIONS
Although the lymphocele rate with Arista AH was 5.7% compared with 10.2% without it, this was not a statistically significant difference potentially because the study was underpowered due to an unusually low baseline rate of lymphoceles. A larger study is warranted to determine whether using a hemostatic agent like Arista AH can prevent lymphoceles.
Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH.
Daniel R
DR
Gilbert
Chesapeake Urology, Westminster, MD.
Jordan
J
Angell
Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH. Electronic address: ronney.abaza@ohiohealth.com.
Ronney
R
Abaza
D001706:Biopsy; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008210:Lymphocele / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications; D011208:Powders / Q000008:administration & dosage; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D013213:Starch / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
C527600:Arista; D006490:Hemostatics; D011208:Powders; D013213:Starch