Clipless laparoscopic retroperitoneal lymph node dissection using bipolar electrocoagulation for sealing lymphatic vessels: initial series.

Abstract

To evaluate the outcome of laparoscopic retroperitoneal lymph node dissection (LRPLND) using bipolar electrocoagulation instead of clipping the lymphatic vessels. Between August 2002 and April 2008, a total of 13 patients underwent transperitoneal LPRLND for nonseminomatous germ cell tumor of the testis. In this experience, in contrast to other techniques, we did not use clips for ligation of the lymphatic vessels; instead, we used bipolar cautery for coagulation of the lymphatic vessels. We followed up the patients for lymphocele formation or lymphatic leakage using abdominal computed tomography scan. Mean age of the patients was 24.2 years (range, 19 to 39 years). Six tumors were on the left side and 7 on the right. Pathological stage was I in 12 patients and IIA in one. The mean follow-up period was 29.9 months (range, 3 to 70 months). No re-operation was required. There was no prolonged lymphatic leakage or lymphocele formation during the follow-up period. Our study demonstrates that using bipolar electrocoagulation instead of clips, for sealing of the lymphatic vessels during LRPLND, does not hamper the outcome of the procedure. This should be further evaluated in randomized clinical trials with more subjects.