Modern lymphatic dissection techniques for preventing post renal transplant lymphocele

Lucan, Ciprian; Jurchis, Ionut; Suciu, Mihai; Selicean, Sonia; Butticé, Salvatore

doi:10.15386/cjmed-716

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…45 Operative time was significantly less in the electrothermal bipolar sealing device-using group. This result is dissimilar to that of the 42 Simforoosh also did not find any case of lymphocele formation when bipolar electrocoagulation was used instead of clips for sealing the lymphatic vessels during laparoscopic retroperitoneal lymph node dissection (LRPLND) (48) .A study by Farouk et al did not find any case of lymphoceles in the electrocoagulation group compared to 2.2% in the suture ligation group. 49 Atray et al also reported lymphoceles in 26% of renal transplant recipients.…”

Section: Discussionmentioning

confidence: 91%

“…This finding is similar to that of Lucan et al who reported a significant decrease in the lymphatic drainage volume when an electrothermal bipolar sealing device was used, compared to conventional techniques: 131.46 ± 54.2 ml vs. 99.8 ± 39.87 ml, p = 0.02. 42 Simforoosh et al also reported that none of their transperitoneal LPRLND patients experienced prolonged lymphatic drainage or lymphocele formation during the follow-up period. 48…”

Section: Discussionmentioning

confidence: 94%

“…Such complications can emerge due to several reasons, including the kind of surgical technique used, and to this date, there are no surgical techniques that can prevent the development of lymphocele. 42 Most studies using electrothermal bipolar sealing device technology in renal transplant surgery have been conducted using various kinds of laparoscopic techniques, some of which have been experimental. The technology was found to be superior to others in terms of sealing time, burst pressure, thermal spread, intraoperative blood loss, operative time, conversion rate, and postoperative course, mostly in the case of donor nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Study to Evaluate the Effect of Using an Electro-Thermal Bipolar Sealing Device and Conventional Ligation on the Incidence of Post-Renal Transplant Lymphoceles in Recipients

Mezban¹,

Almayyahi

Mahdi

et al. 2022

IqNJM

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Background: Lymphocele development is a well-established complication following kidney transplant. Some devices, such as electrothermal bipolar sealing devices, have been found to reduce lymphatic drain following kidney transplantation. The aim of the study: The purpose of the study is to compare the usage of conventional lymphatic ligation with the electrothermal bipolar sealing device and its influence on the formation of lymphoceles after kidney transplantation surgery. Patients and methods: A cohort retrospective and prospective study was conducted from May 2015 to November 2020 at the Basrah renal transplantation center in Al-Sader Teaching Hospital, Basrah. One hundred and thirty anonymized patients with end-stage renal diseases were involved in the present study. They were categorized into two groups: group 1 (conventional ligation group) with 70 patients and group 2 (electrothermal bipolar sealing device group) with 60 patients. The groups were compared and matched for possible risk factors. Patients were followed up for six weeks with full laboratory investigation (complet blood count, renal function tests, and liver function tests) and medical and surgical assessments. Statistical package of social siences version 25 was used for the statistical analysis of the data. Confidence intervals of 95% were applied as the dependent interval in statistics, and p-values < 0.05 were considered significant. Results: The mean age of the patients was parallel for both conventional ligation and electrothermal bipolar sealing device groups (34.69 ± 10.28 vs. 33.68 ± 10.35). The operative time (155.57 ± 17.9 vs. 140.33 ± 17.07), lymphocele development (12 (17.1%) vs. 4 (6.7%)), lymphatic drainage volume (974.57 ± 178.39 vs. 493.83 ± 163.65), and the days of drainage (8.28 ± 3.3 vs. 4.6 ± 1.4) showed statistically significant differences between the conventional ligation technique and the electrothermal bipolar sealing device technique (p < 0.05). Conclusion: The cautery of bipolar vessels is advantageous when compared to conventional ligation in kidney transplant lymphatic dissection, reducing the risk of lymphocele occurrence, in addition to its feasibility, safety, and easy performance

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Comparative Study to Evaluate the Effect of Using an Electro-Thermal Bipolar Sealing Device and Conventional Ligation on the Incidence of Post-Renal Transplant Lymphoceles in Recipients

Mezban¹,

Almayyahi

Mahdi

et al. 2022

IqNJM

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“…In our study, the combination of bipolar electrocoagulation, tie ligating with non-absorbable suture, and or clipping were applied. Electrothermal bipolar sealing device (LigaSure) has been used in some centers to decrease lymphatic leakage [ 19 ]. Other preventive procedures, such as the application of polymeric sealant or povidone iodine during the transplantation, have been described, but these were either not cost-effective, off-label, or did not decrease the incidence of lymphocele after KTx significantly [ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Peritoneal Fenestration during Kidney Transplantation Can Reduce the Type C Lymphocele Formation

Golriz

Sabagh

Emami

et al. 2021

JCM

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Lymphocele is a common complication following kidney transplantation (KTx). We aimed to evaluate the preventive effect of peritoneal fenestration during KTx in reducing lymphocele. From January 2001, the data of all KTx were prospectively gathered in our digital data bank. From 2008, preventive peritoneal fenestration was performed as a routine procedure for all patients with KTx. Between 2001 and 2008, 579 KTx were performed without preventive peritoneal fenestration. To compare the results between with and without peritoneal fenestration, the same number of patients after 2008 (579 patients) was included in this study. The pre-, intra-, and postoperative data of the patients in these two groups were analyzed and compared, especially regarding the postoperative different types of lymphocele formation. The mean recipient age was 52.6 ± 13.8, and 33.7% of the patients were female. Type C lymphocele was significantly lower in the group with preventive fenestration (5.3% vs. 8.8%, p = 0.014 for 31/579 vs. 51/579). Peritoneal dialysis and implantation of the kidney in the left fossa were independently associated with a higher rate of type C lymphocele (OR 2.842, 95% CI 1.354–5.967, p = 0.006 and OR 3.614, 95% CI 1.215–10.747, p = 0.021, respectively). The results of this study showed that intraoperative preventive peritoneal fenestration could significantly reduce type C lymphocele.

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“…Lymphoceles can lead to further complications, such as impaired wound healing, thrombosis, and organ failure. The reported incidences of lymphoceles after KTx vary widely (from 0.6% to 51%) [ 2 , 3 , 4 ]. This vast discrepancy in the reported incidences can be attributed to the lack of a standardized definition for post-KTx lymphatic complications but also to differences in the means of routine postoperative diagnosis and distinct follow-up protocols [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Validating Consensus-Defined Severity Grading of Lymphatic Complications after Kidney Transplant

Sabagh

Mohammadi

Ramouz

et al. 2021

JCM

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Lymphatic complications after kidney transplantation (KTx) are associated with morbidities such as impaired wound healing, thrombosis, and organ failure. Recently, a consensus regarding the definition and severity grading of lymphoceles has been suggested. The aim of the present study was to validate this classification method. All adult patients who underwent KTx between December 2011 and September 2016 in our department were evaluated regarding lymphoceles that were diagnosed within 6 months after KTx based on the recent definition. Patients with lymphoceles were categorized according to the classification criteria, and clinical outcomes were compared between the groups. In our department, a total of 587 patients underwent KTx between 2011 and 2016. Lymphoceles were detected after KTx in 90 patients (15.3%). Among these patients, 24 (26.6%) had grade A lymphoceles, 14 (15.6%) had grade B, and 52 (57.8%) had grade C. The median duration times of intermediate care (IMC) and hospital stay were significantly higher among patients with grade C lymphoceles than they were among patients with grade A and B lymphoceles. Significantly more patients with grade C lymphoceles were readmitted to the hospital for treatment. The recently published definition and severity grading of lymphoceles after KTx is an easy-to-use and valid classification system, which may facilitate the comparison of results from different studies on lymphoceles after KTx.

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Modern lymphatic dissection techniques for preventing post renal transplant lymphocele

Cited by 8 publications

References 20 publications

Comparative Study to Evaluate the Effect of Using an Electro-Thermal Bipolar Sealing Device and Conventional Ligation on the Incidence of Post-Renal Transplant Lymphoceles in Recipients

Comparative Study to Evaluate the Effect of Using an Electro-Thermal Bipolar Sealing Device and Conventional Ligation on the Incidence of Post-Renal Transplant Lymphoceles in Recipients

Prophylactic Peritoneal Fenestration during Kidney Transplantation Can Reduce the Type C Lymphocele Formation

Validating Consensus-Defined Severity Grading of Lymphatic Complications after Kidney Transplant

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