Technical Caveats And Tips

■ A preoperative computed tomography scan gives the best definition of size and location of the lymphocele cavity. This study can determine the relationship of the lymphocele cavity to the bladder and the renal allograft.

■ Aspirated fluid creatinine and blood urea nitrogen are helpful to distinguish between a lymphocele and an urinoma. A gram stain and culture help to determine if the lymphocele is infected.

■ Careful laparoscopic dissection will prevent injury to the transplanted ureter or renal vessels.

■ In selected cases, a portion of the omentum can be placed in the lymphocele cavity to keep the cavity open for drainage.

The most common complication (7% of cases) of laparoscopic marsupialization of lymphocele is injury to adjacent structures, especially transection of the transplanted ureter.

If intraoperatively the lymphocele is found to be infected, conversion to an open procedure is required.

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