Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.

A prompt consideration of the diagnosis of torsion of kidney transplant is required to prevent delay in surgical intervention. We recommend urgent Doppler ultrasound be used as first-line investigation, followed by prompt surgical exploration. We recommend the use of prophylactic nephropexy to prevent torsion.

Introduction: Lymphocele is a complication of kidney transplantation. We present a review of the current status of surgical and nonsurgical treatment of primary symptomatic lymphocele after kidney transplantation. Methods. Studies were identified by searching Medline and Embase for articles from January 1954 to January 2010 using the keywords "kidney transplantation" and "lymphocele". Additional papers were identified by a manual search of references from key articles. Case series of less than 5 patients and case reports were excluded. Two aspects of primary symptomatic lymphocele management after kidney transplantation were analyzed. First, surgical treatment was compared with non-surgical treatment. Second, within the surgical treatment group, laparoscopic drainage was compared with open drainage. Results. Forty-four studies with 948 cases of primary lymphocele were included for analysis. There was significant difference in the rate of recurrent lymphocele formation between surgical and non-surgical treatment of primary symptomatic lymphocele (9% versus 54%, p=0.00001). No significant difference in recurrence rate (6% versus 14%, p=0.79), intraoperative complication rate (4% versus 1%, p=0.47) or postoperative complication rate (3% versus 5%, p=0.14) was demonstrated between the laparoscopic and open surgical groups. The open conversion rate was 7%. Mean hospital stay was 2.7 days in the laparoscopic group, and 5.7 days in the open group. Conclusions. Evidence in the medical literature showed that surgical drainage (including laparoscopic and open) of primary lymphocele after kidney transplantation was more effective than non-surgical treatments, such as simple aspiration, sclerotherapy and catheter placement. There was little evidence to support the superiority of laparoscopic drainage, although there was a trend towards decreased hospital stay in the laparoscopic group.

Purpose Wet laboratories are becoming an increasingly important training tool as part of a push to a proficiency-based training model. We created a microsurgical wet laboratory to investigate the utility of histopathology use in assessing surgical outcomes and determine the learning curve of a novel microsurgical procedure. Methods A microsurgical wet laboratory was established using pig eyes to simulate the human cornea. Three novice surgeons and an experienced surgeon performed an anterior cornea lamellar dissection and the duration of the procedure was recorded. With the aid of histological analysis, the thickness and characteristics of the dissected graft was recorded. The number of attempts to complete the experiment, defined as three successful dissections with mean thickness below 100 μm, was documented. Results The use of histopathology was highly successful allowing in-depth analysis of the dissected graft for each attempt. Trainees reached the endpoint of the study in 21, 26 and 36 attempts (mean: 28 attempts) whilst the corneal surgeon completed the experiment in 12 attempts (p = 0.07). Mean dissection thickness decreased over time for all participants. The mean dissection time for trainees was 10.6 ± 4.2 min compared to the corneal surgeon with a mean of 8.2 ± 3.1 min (p = 0.03). Conclusion We propose a corneal wet laboratory model that allows for simple, efficient, and flexible microsurgical training. The use of histopathological analysis allows for careful graft analysis, providing objective feedback throughout the training exercise. Trainees demonstrated improvements in the three key aspects of the procedure: accuracy as evidenced by decreasing histological thickness, confidence by self-report and fluidity by decreasing duration of the procedure.