Treatment With Intraoperative Patent Blue V Dye of Refractory Lymphocele After Inguinal Lymphadenectomy for Squamous Cell Penile Carcinoma

Intraoperative mapping with isosulfan blue of lymphatic leakage during inguinal lymph node dissection (ILND) for skin cancer for the prevention of postoperative lymphocele

“…Isosulfan blue dye is taken up selectively by the lymphatic system and used for sentinel node biopsy in patients with cutaneous melanoma, other cutaneous malignancies, breast cancer, and thyroid cancer 11–14, 29. Recently, it has also been used to identify and ligate the injured lymphatics causing lymphoceles that result from femoral vessel cannulation for cardiopulmonary bypass, arterial bypass and cardiac catheterization procedures, resection of malignant groin tumors, and ILND 15–17. In our study, we postulated that intraoperative use of isosulfan blue for identification of injured lymphatics during ILND would prevent postoperative lymphocele.…”

“…Isosulfan blue is currently used for sentinel node evaluation in patients with cutaneous melanoma, breast cancer, or thyroid cancer 11–14 and is effective in delineating the course of lymphatic channels. Isosulfan blue is a safe and easy‐to‐use agent that has few side effects and has also been used to identify and treat lymphoceles arising from lymphatics injured during surgery of the groin region such as during femoral vessel cannulation, saphenous vein harvesting, tumor excision, and ILND 15–17. However, the preventive use of dye at the time of ILND has not been reported.…”

Ligation of lymph vessels for the treatment of recurrent inguinal lymphoceles following lymphadenectomy

“…Previous literature regarding ligature of lymph vessels is very sparse, but previous case reports and series all show improvement postoperatively in all cases [ 3 – 5 ]. In our series, we show that the need for puncture does not necessarily end right after surgery and one can expect that in some cases, there will be a need for further drainage in the first few weeks postoperatively.…”

“…In general, this condition is self-limiting, but in some cases, there is no end in sight for the recurrence of the lymphocele. In the last decades, a few case reports and small series have suggested that using patent blue to identify leaking lymph vessels could be the solution to this problem [ 3 – 5 ].…”