J Gynecol Oncol.  2014 Jul;25(3):229-235. 10.3802/jgo.2014.25.3.229.

Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device

• Tsuda N
• Ushijima K
• Kawano K
• Takemoto S
• Nishio S
• Sonoda G
• Kamura T

• KMID: 2130104
• DOI: http://doi.org/10.3802/jgo.2014.25.3.229

Abstract

OBJECTIVE
A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy.
METHODS
A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups.
RESULTS
Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device.
CONCLUSION
Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.

Keyword

Electrothermal bipolar vessel sealing device; Gynecologic cancer; LigaSure; Lymphocele; Pelvic lymphadenectomy; Venous thrombosis

MeSH Terms

Adult
Electrocoagulation/instrumentation/*methods
Female
Genital Neoplasms, Female/pathology/*surgery
Humans
Lymph Node Excision/adverse effects/*methods
Lymphatic Metastasis
Lymphocele/etiology/*prevention & control
Middle Aged
Neoplasm Staging
Pelvis
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Boxed parts indicate: (1) the level of the femoral canal, on the ventral walls of external iliac vessels; (2) the level of obturator fossa, where numerous channels are connected with the lateral parametria; and (3) the bifurcation of common iliac vessels, cranially to the internal iliac vessels, and medial to the external iliac vessels. We performed double sealing of the lymphatic vessel edge at the level of the obturator fossa by LigaSure small jaw.

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