Ligaclip Prevents Lymphoceles Following Pelvic Lymphadenectomy

Clipping lymph ducts is better than bipolar coagulation at preventing lymphoceles after laparoscopic pelvic lymphadenectomy (LPL), according to a new study.

Researchers at the Catholic University of the Sacred Heart (Rome, Italy) conducted a prospective randomized pilot study that compared the use of the Ligaclip, a product of Ethicon Endo-Surgery (Cincinnati, OH, USA), with bipolar coagulation in preventing lymphoceles after LPL for gynecologic cancer. A total of 30 female patients with gynecologic malignancy (15 patients with endometrial cancer and 15 with cervical cancer) underwent LPL of all lymphatic tissue in the common iliac, external iliac, internal iliac, obturator, and sacral or presacral regions, plus the vascular part of the cardinal ligament in patients with cervical cancer. The women were then assigned to bipolar coagulation to seal lymphatic vessels on one side, while 10-mm titanium Ligaclips were used to compress the lymphatic vessels on the other side.

The researchers found that when a vaginal ultrasound examination was performed six weeks later, lymphocele were present in 10 patients (33%). Lymphocele had developed in 9 (30%) patients on the side where LPL was performed using bipolar coagulation, but in only one patient on the side where it was performed using the Ligaclip. On univariate analysis, the incidence of lymphocele was not related to body mass index, tumor type, other surgical procedures, or number of lymph nodes removed. The only predictor was bipolar coagulation versus Ligaclip use. The study was published ahead of print on August 17, 2010, in the American Journal of Obstetrics & Gynecology.

"This study demonstrates that the use of the Ligaclip to close lymphatic vessels may reduce the incidence of lymphoceles in patients undergoing laparoscopic pelvic lymphadenectomy,” concluded lead author Valerio Gallotta, M.D., and colleagues of the division of gynecologic oncology.

"Since the clip merely mechanically closes the 'tube' or lymph channel, it stands to reason that the clip would be more effective in preventing lymphocele compared to electrocautery,” commented Edward Chekan, M.D., a medical affairs director at Ethicon Endo-Surgery. "In lymph channels there is no blood, so there is little chance to form blood clot by using electrocautery.”

Related Links:
Catholic University of the Sacred Heart
Ethicon Endo-Surgery