urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2024-12-3-88-96urovest-886Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESХирургическая техника профилактики развития лимфогенных осложнений при робот-ассистированной радикальной простатэктомии и тазовой лимфаденэктомииSurgical technique for preventing lymphatic complications during robot-assisted radical prostatectomyhttps://orcid.org/0000-0001-6651-8142СкрупскийК. С.SkrupskiyK. S.

Константин Сергеевич Скрупский

Москва

Konstantin S. Skrupskiy

Moscow

89_sks@mail.ruhttps://orcid.org/0000-0003-4511-5998КолонтаревК. Б.KolontarevK. B.

Константин Борисович Колонтарев — д-р мед. наук, профессор

Москва

Konstantin B. Kolontarev — Dr.Sc.(Med), Full Prof.

Moscow

kb80@yandex.ruhttps://orcid.org/0000-0003-3299-0574ГоворовА. В.GovorovA. V.

Александр Викторович Говоров — д-р мед. наук

Москва

Aleksandr V. Govorov — Dr.Sc.(Med)

Moscow

dr.govorov@gmail.comhttps://orcid.org/0009-0008-2961-1688ДьяковД. В.DyakovV. V.

Владимир Валентинович Дьяков — канд. мед. наук

Москва

Vladimir V. Dyakov — Cand.Sc.(Med)

Moscow

dr.diakov@gmail.comhttps://orcid.org/0000-0002-6703-5238СаруханянА. Л.SarukhanianA. L.

Арман Львович Саруханян

Москва

Arman L. Sarukhanian

Moscow

i@sarukhanian.ruhttps://orcid.org/0000-0002-4708-1683ГрицковИ. О.GritskovI. O.

Игорь Олегович Грицков

Москва

Igor O. Gritskov

Moscow

grickoff@mail.ruhttps://orcid.org/0000-0002-6096-5723ПушкарьД. Ю.PushkarD. Yu.

Дмитрий Юрьевич Пушкарь — д-р мед. наук, профессор, акад. РАН

Москва

Dmitry Yu. Pushkar — Dr.Sc.(Med), Full Prof., Acad. of the RAS

Moscow

pushkardm@mail.ruГородская клиническая больница им. С. П. БоткинаРоссияBotkin City Clinical HospitalRussian FederationГородская клиническая больница им. С. П. Боткина; Российский Университет МедициныРоссияBotkin City Clinical Hospital; Russian University of Medicine (RosUniMed)Russian FederationРоссийский Университет МедициныРоссияRussian University of Medicine (RosUniMed)Russian Federation2024080720241238896Copyright © Скрупский К.С., Колонтарев К.Б., Говоров А.В., Дьяков Д.В., Саруханян А.Л., Грицков И.О., Пушкарь Д.Ю., 20242024Скрупский К.С., Колонтарев К.Б., Говоров А.В., Дьяков Д.В., Саруханян А.Л., Грицков И.О., Пушкарь Д.Ю.Skrupskiy K.S., Kolontarev K.B., Govorov A.V., Dyakov V.V., Sarukhanian A.L., Gritskov I.O., Pushkar D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/886Введение

Введение. Радикальная простатэктомия (РПЭ) является «золотым стандартом» хирургического лечения пациентов с локальным раком предстательной железы (РПЖ). При этом нередко выполняется тазовая лимфаденэктомия (ТЛ), являющаяся лечебной и диагностической манипуляцией. Формирование лимфоцеле является наиболее частым осложнением робот-ассистированной радикальной простатэктомии (РАРП) и ТЛ.

Цель исследования

Цель исследования. Разработка хирургической методики, направленной на снижение частоты возникновения лимфоцеле у пациентов, перенёсших РАРП с ТЛ, а также оценка её эффективности и безопасности.

Материалы и методы

Материалы и методы. В исследование включены 49 пациентов перенесших РАРП и ТЛ. Пациенты были рандомизированы в 2 группы: группа пациентов (n = 25), которым после завершения радикального лечения и региональной лимфодиссекции выполняли фиксацию свободного лоскута брюшины к лобковой кости; контрольная группа пациентов (n = 24) — без фиксации брюшины. Средний период наблюдения составил 3 месяца.

Результаты

Результаты. Существенных различий в предоперационных характеристиках, интра- и послеоперационных показателей между двумя группами не было. В послеоперационном периоде лимфоцеле имело место у 5 (10,2 %) больных. В группе фиксации лоскута брюшины у 1 (4%) пациента против 4 (16,7%) в группе без фиксации лоскута. Существенных различий в объёме лимфоцеле между группами не отмечено. Лимфоцеле в группе фиксации лоскута брюшины было асимптомным. Симптоматическое лимфоцеле было диагностировано у одного (4,2%) пациента контрольной группы.

Заключение

Заключение. Методика фиксации свободного лоскута брюшины к лобковой кости при РАРП с ТЛ позволяет снизить частоту формирования лимфоцеле в послеоперационном периоде.

Introduction

Introduction. Radical prostatectomy (RP) stands the gold standard method of treatment for localised prostate cancer. Pelvic lymph node dissection (PLND) is a common surgical procedure that can be used for both diagnostic and therapeutic purposes. Lymphocele is the most common complication after robot-assisted radical prostatectomy (RARP) and PLND.

Objective

Objective. To develop a surgical technique aimed at reducing the incidence of lymphocele in patients who underwent RARP with TL and to evaluate its efficacy and safety.

Materials & methods

Materials & methods. The study included 49 patients who underwent RARP and PLND. The patients were divided into 2 groups: group 1 — patients with free peritoneal flap fixed to the pubic bone after RARP and PLND (n = 25) and group 2 — control group «without peritoneal flap fixation» (n = 24). The average follow-up period was 3 months.

Results

Results. No significant differences in clinical parameters were observed between the groups in perioperative period. In postoperative period lymphocele was diagnosed in 5 (10.2%) patients: group 1 — 1 (4%) patients, group 2 — 4 (16.7%). There were no significant differences in lymphocele volume between the groups. In group 1 lymphocele had no clinical manifestation. Symptomatic lymphocele was diagnosed in 1 patient (4.2%) from the control group.

Conclusion

Conclusion. The surgical technique of a free peritoneal flap fixation to the pubic bone combined with PLND after RARP may reduce the incidence of lymphocele if compared to the standard technique.

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The authors declare that there are no conflicts of interest present.