To Clip or Not to Clip? - Renal and Urology News

To Clip or Not to Clip?

Slideshow

  • CT scan in a patient 1 month following robotic prostatectomy

    ClinQuiz_Sept16

    CT scan in a patient 1 month following robotic prostatectomy

  • CT scan in a patient 1 month following robotic prostatectomy

    ClinQuiz2_Sept16

    CT scan in a patient 1 month following robotic prostatectomy

A 54-year-old man underwent robotic prostatectomy and extended lymph node dissection for high risk cT2bN0M0 adenocarcinoma of the prostate (5 of 12 cores Gleason 4+4=8, PSA level of 8.4 ng/mL). One month post-operatively, he presented to an emergency room with dysuria and fever. A computed tomography (CT) scan that was obtained is shown. 

This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.References  Grande P, Di Pierro GB, Mordasini L, et al. Prospective randomized trial comparing titanium clips to bipolar coagulation in sealing lymphatic vessels during pelvic lymph...

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This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.

References 

  1. Grande P, Di Pierro GB, Mordasini L, et al. Prospective randomized trial comparing titanium clips to bipolar coagulation in sealing lymphatic vessels during pelvic lymph node dissection at the time of robot-assisted radical prostatectomy. Eur Urol 2016; published online ahead of print.
  1. Lebeis C, Canes D, Sorcini A, and Moinzadeh A. Novel technique prevents lymphoceles after transperitoneal robotic-assisted pelvic lymph node dissection: peritoneal flap interposition. Urology 2015;85:1505-1509.

Answer: C

The CT scan demonstrates a post-operative left pelvic lymphocele. Recent prospective randomized data suggests no difference between titanium clip application and bipolar electrocautery in avoiding this complication.1 Some investigators have suggested that a peritoneal flap interposition may be the solution for preventing this issue.2

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