Laparoscopic treatment of lymphoceles following kidney transplantation by intraperitoneal fenestration and omentoplasty

Abstract

The recent development of endoscopic surgery and its use in treating several abdominal and thoracic surgical pathologies lead us to suggest its application in the treatment of posttransplant lymphoceles. The authors report two cases treated by the laparoscopic approach. Recurrence occurred in one of them. The technique is described and its place among other therapeutic modalities is discussed.

Laparoscopic fenestration of posttransplant lymphoceles

“…The operative strategy is to perform a peritoneal fenestration through a laparotomy, minilaparotomy, or via a laparoscopic approach. Some authors suggest the use of an omentum ap to decrease the risk of lymphocele relapse, but others do not [3±5, 14,30]. Recently, laparoscopic fenestration of posttransplant lymphoceles has been reported in the literature (Table 4) [1,6,8,9,11,15,16,19,25,28,31,32,36,38].…”

“…Several attempts have been made to increase the eciency of drainage, but none of these alternative approaches have found widespread acceptance. For instance, most authors do not routinely use omental packing, although it is said to improve results in terms of successful drainage and helps to avoid internal hernias [3,30]. Hsu et al [16] reported on 81 patients from nine institutions who underwent a laparoscopic lymphocele fenestration.…”

“…Gill et al [11] punctured the lymphocele percutaneously with a needle that they diametrically moved through the lymphocele cavity until the laparoscopist could see it entering the abdominal cavity. Other authors prefer the instillation of methylene blue into the lymphocele sac [9,25,30,32,38].…”

“…For the conservative treatment of posttransplant lymphoceles percutaneous needle aspiration, continuous drainage over a de®ned period of time via various kinds of catheters, and sclerotherapy with several agents have been proposed [2, 4, 10, 12, 14, 22, 24, 26, 33, 34, 37, 39, 40, 42±46]. Operative strategies include a peritoneal fenestration through a laparotomy, minilaparotomy, or via a laparoscopic approach [1±5, 13,23,26,27,30,33,34,43].…”

Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section

“…Surgical procedures are greatly facilitated by the increased visibility it affords; however [9], greater skill is required and the performance of such operations is more demanding than open surgery [5]. Therefore, experience in both approaches is mandatory, particularly in case conversion is needed.Training in laparoscopic surgery is usually obtained by performing phantom operations using a pelvic trainer, by doing experimental surgery or by practicing on cadavers [15]; more recently, virtual reality technology has also been applied to surgical training [20].The laparoscopic approach has been used in cadavers to practice certain abdominal procedures [1,2,6,7,10,13,14,16,17], for necropsies [3,8], for experimental purposes [10], and also to teach anatomy [12].With some exceptions, rigor mortis in embalmed cadavers has been considered a limiting factor during the creation of the pneumoperitoneum [14,17]. Certain procedures have been devised to manage this problem, such as ethanol and glycerin injections in the femoral vein with vigorous abdominal massage [10,16], insufflation with compressed air [18], gasless laparoscopy with an abdominal lifter [7], and abdominal wall resection [13].…”