Objective: Lymphocele is a common complication caused by incomplete closure of afferent lymphatic vessels. Robotic surgery platform has advantages in manipulating tissues finely and has been reported to reduce blood loss during gynecologic surgery. In this study we investigated whether robot surgery can secure the leakage from lymphatic vessels damaged during lymphadenectomy.
Methods: In this retrospective study, a total of 92 patients with gynecologic cancer was evaluated who underwent pelvic lymphadenectomy with either Robot assisted laparoscopic surgery (RALS, n=42) or standard laparoscopic surgery (LS, n=50) in a single institution. The patients were excluded who had previous surgery or radiation in abdomen. We compared postoperative outcomes of RALS to that of LS.
Results: The number of pelvic lymph node removed was indifferent (18.5 in LS vs. 18.3 in RALS, p=0.890). RALS group needed longer surgery time (293.5 m vs. 255.0 m, p=0.021) and less transfusion (9.5% vs. 32.0%, p=0.009). The amount of drainage and total duration of drainage after surgery were less in RALS group (343.2 vs. 459.7 ml at postoperative 2 days, p=0.024 and 7.2 vs. 9.8 days, p=0.012, respectively). Lymphocele tended to develop less in RALS group (8/42) than in LS group (14/50) although statistically insignificant (p=0.316). Five patients in LS group and only one patient in RALS group were treated due to infected lymphocele (10.0% vs. 2.4%, p=0.214).
Conclusion: In this study, robot surgery platform seems to enhance ligation of lymphatic vessels and reduce lymphatic drainage which may contribute to reduction of lymphocele development after pelvic lymphadenectomy. Further studies with larger sample size are necessary to validate our results.