USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (all authors).

ABSTRACT

Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported.

Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia.

Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.

Key Words: Lymphocele, Radical prostatectomy, Robotics, Complications.

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Department of Urology, All India Institute of Medical Sciences, New Delhi, India (all authors).

ABSTRACT

Introduction: Laparoscopic port site metastases are recurrent nodular lesions developing locally in the abdominal wall within the scar tissue of one or more trocar sites. We are reporting an extremely rare case of delayed multiple port site metastases 3 years after laparoscopic radical prostatectomy. In this case, 3 port site metastases appeared 3 years after laparoscopic radical prostatectomy.

Case Description: A 65-year-old man was evaluated for lower urinary tract symptoms and found to have raised serum prostate-specific antigen of 9.06 ng/mL. Transrectal ultrasonography-guided biopsy of the prostate revealed an adenocarcinoma of the prostate (Gleason score 3 4 7), with 5 of 12 cores positive for tumor. Contrast-enhanced computed tomography showed localized disease with no involvement of seminal vesicle or lymph nodes. The bone scan was normal. He underwent laparoscopic radical prostatectomy for localized carcinoma of the prostate. He developed 3 port site metastases 3 years after surgery. In view of multiple port site metastatic disease, bilateral orchiectomy was done. The patient is doing well after 1 year of follow-up.

Conclusion: We report an occurrence of delayed multiple port site metastases after laparoscopic radical prostatectomy. The 3 sites of metastases in our case included the extraction site, the most active instrument site, and the drain placement site.

Key Words: Laparoscopy, Metastases, Multiple, Port sites, Radical prostatectomy.

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