Early evaluation of the efficacy of radioguided surgery in reducing the incidence of lymphocele and lower limb lymphedema after robot-assisted prostatectomy with pelvic lymph node dissection

Trishkin M.D., Shpot E.V., Chernov Ya.N., Chinenov D.V., Votyakov A.Yu., Hizriev H.A., Astakhova X.A., Kurepta I.N., Smirnova E.A., Smoleevskiy A.G., Glybochko P.V.

1) Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; 2) N.V. Sklifosovskiy Institute of Clinical Medicine of the I.M. Sechenov First Moscow State Medical University Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

Introduction. Robot-assisted radical prostatectomy (RARP) with pelvic lymphadenectomy (PLND) is the «gold standard» for the surgical treatment of prostate cancer with the risk of lymphatic involvement ≥5% according to predictive nomograms. PLND is associated with the development of lymphatic complications (lymphocele, lymphedema) with a frequency up to 51%.
Aim. To evaluate the effectiveness of intraoperative navigation technique via a gamma probe and lymphotropic tracer (99mTc) during RARP with PLND to prevent the incidence of postoperative lymphatic complications.
Materials and methods. A single-center prospective study conducted between 2024 to 2025. The study included 50 patients with intermediate and high oncological risk according to the D’Amico classification. In the main group (n=23), RARP with PLND were performed with preservation of the lymphatic ducts of the lower limbs (LL). In the control group (n=27) RARP with PLND without LL lymphatic ducts preservation were performed. The frequency of the postoperative lymphatic complications was the primary endpoint, an evaluation of the intraoperative and postoperative complications was the secondary endpoint.
Results. Two patients in the main group developed lymphocele, which subsequently resolved within three months, compared with eight lymphoceles in the control group, one of which required repeat surgery. Lymphedema developed in one patient in the main group, compared with three patients in the control group. Intraoperative and postoperative parameters in the study group were comparable to those in the control group.
Conclusions. The use of radioguided surgery with lymphotropic tracer (99mTc) during RARP with PLND can reduce the risk of complications associated with the operation. The approach described above may be a promising solution to the problem of postoperative lymphatic complications.

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About the Authors

Corresponding author: M.D. Trishkin – Ph.D. student, Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia, e-mail: maxtrishkin@bk.ru

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