V12-11 Surgical Treatment of Lower Limb Lymphedema After Robot Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology II (V12)1 May 2024V12-11 SURGICAL TREATMENT OF LOWER LIMB LYMPHEDEMA AFTER ROBOT ASSISTED RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION Giovanni Drocchi, Giovanni Marchi, Stefano Tappero, Sara Dessalvi, Stefano Parodi, Francesco Chierigo, Giovanni Guano, Lorenzo Lo Monaco, Marco Martiriggiano, Enrico Vecchio, Francesca Ambrosini, Marco Borghesi, Carlo Terrone, and Francesco Boccardo Giovanni DrocchiGiovanni Drocchi , Giovanni MarchiGiovanni Marchi , Stefano TapperoStefano Tappero , Sara DessalviSara Dessalvi , Stefano ParodiStefano Parodi , Francesco ChierigoFrancesco Chierigo , Giovanni GuanoGiovanni Guano , Lorenzo Lo MonacoLorenzo Lo Monaco , Marco MartiriggianoMarco Martiriggiano , Enrico VecchioEnrico Vecchio , Francesca AmbrosiniFrancesca Ambrosini , Marco BorghesiMarco Borghesi , Carlo TerroneCarlo Terrone , and Francesco BoccardoFrancesco Boccardo View All Author Informationhttps://doi.org/10.1097/01.JU.0001009480.90141.21.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower limb lymphedema is a disabling complication of robot-assisted radical prostatectomy with pelvic lymph node dissection (RARP and LND). Initial treatment consists of decongestive physiotherapy. In case of poor stability, recurrent lymphangitis, and/or progression of lymphedema, surgical treatment should be considered. A valid surgical treatment option consists of micro-surgical lymphatic-venous anastomosis (MLVA). The current video displays the key surgical steps of MLVA, based on a specific case of cancer-related left lower limb lymphedema after RARP and LND. METHODS: The current video (produced in March 2023) reports the clinical case of a 58-year-old male patient diagnosed with cancer-related left lower limb lymphedema after 18 months from RARP and LND for prostate cancer (GS 4+3, pT3a-pN1, three positive nodes on total 11 removed nodes). Lymphedema-related symptoms consisted of cutaneous swelling, pain and deambulation difficulty. Superficial and deep lymphatic circulation was assessed with preoperatory lymphoscintigraphy, which revealed absence of lymphatic return from the left lower extremity. MLVA was performed under the left groin crease. Lymphatic vessels were visualized after injection of blue dye and indocyanine green at five sites from the internal to the anterior surface of the thigh, into the dermal, subcutaneous and epifascial areas. For the lymphatic-venous anastomosis, the operating microscope (10-15x) was used. The patency of the lymphatic afferent was confirmed based on leakage of lymph. The superficial external pundendal vein was isolated and prepared for the anastomosis. The dissection of the venous tunica avventitia was performed in order to reduce the risk of anastomotic stricture, potentially due to the vasa nervorum hypertone. Two lymphatic vessels were then dunked into the venous branch through a sleeve technique, and the anastomosis performed with an invaginating running suture with U-shaped 8/0 stitch. The patency of the MLVA was checked at the operating microscope based on passage of blue dye from the lymphatics into the vein. RESULTS: Operative time was 90 minutes, and no intra-operatory complication occurred. Post-operatory period was uneventful, and the patient was discharged in second post-operatory day. At four months after MLVA, the left lower limb lymphedema was consistently reduced, and lymphedema-related symptoms were controlled. CONCLUSIONS: Lower limb lymphedema may affect a non-negligible rate of patients treated with RARP and LND for prostate cancer. An effective treatment, in case of unresponsiveness to conservative therapy, consists of micro-surgical lymphatic-venous anastomosis. This is an ultra-specialistic surgery, which demands referral to high-volume and high-expertise centres. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e998 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giovanni Drocchi More articles by this author Giovanni Marchi More articles by this author Stefano Tappero More articles by this author Sara Dessalvi More articles by this author Stefano Parodi More articles by this author Francesco Chierigo More articles by this author Giovanni Guano More articles by this author Lorenzo Lo Monaco More articles by this author Marco Martiriggiano More articles by this author Enrico Vecchio More articles by this author Francesca Ambrosini More articles by this author Marco Borghesi More articles by this author Carlo Terrone More articles by this author Francesco Boccardo More articles by this author Expand All Advertisement PDF downloadLoading ...