A Novel Peritoneal Channel Technique Using a Hemostatic Agent to Minimize Symptomatic Fluid Collections After Single-Port Robot-Assisted Radical Prostatectomy

A Novel Peritoneal Channel Technique Using a Hemostatic Agent to Minimize Symptomatic Fluid Collections After Single-Port Robot-Assisted Radical Prostatectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Novel Peritoneal Channel Technique Using a Hemostatic Agent to Minimize Symptomatic Fluid Collections After Single-Port Robot-Assisted Radical Prostatectomy Jacob O'Hara, Ahmed Shalaby, Katerina Lembrikova, Sonam Saxena, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8951278/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Apr, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction Symptomatic fluid collections are a source of morbidity for patients after single-port (SP) robot assisted radical prostatectomy (RARP). We previously demonstrated a reduction in fluid collections by over 50% using peritoneal windows. This study represents the first reported use of a hemostatic agent to maintain peritoneal window patency, promoting wicking and reabsorption of postoperative fluid collections. Methods The institution’s IRB-approved prostate cancer database was used to identify 467 patients who underwent extraperitoneal SP RARP by two surgeons from January 2021 to September 2025. Patients were stratified into cohorts based on surgical technique for prevention of postoperative fluid collection: (1) peritoneal window, (2) peritoneal window with Surgicel, and (3) neither (control). Symptomatic fluid collections were defined as having lower abdominal/pelvic pain, worsening urgency/frequency, or fever. Results Among 467 patients, symptomatic fluid collections were rare across groups. The Surgicel cohort (n = 77) had no symptomatic collections and no drainage procedures, compared to 10 symptomatic cases in the control group (n = 195) and 4 in the peritoneal window group (n = 195) (p = 0.005). Asymptomatic collections occurred in 3 patients from the Surgicel cohort (3.9%), none requiring intervention. Conclusion We demonstrate a novel technique using hemostatic mesh to create a channel from the prostatectomy bed to the peritoneum after extraperitoneal SP RARP. This technique markedly reduced the incidence of symptomatic fluid collections and trends toward the reduction of overall collections. This technique is less complex and more time-efficient than the peritoneal window technique. Surgeons seeking to reduce the incidence of symptomatic fluid collections after extraperitoneal SP RARP should consider this technique. Lymphocele Radical prostatectomy Peritoneal window Single port Robot-assisted Figures Figure 1 Figure 2 Introduction Post-operative fluid collections are one of the most common complications following robot-assisted radical prostatectomy (RARP). Most commonly, these fluid collections are lymphoceles and usually develop after RARP with pelvic lymph node dissection (PLND), with current literature estimating an incidence of symptomatic lymphoceles to be 2.5–15.4% [1–3]. These fluid collections become symptomatic secondary to mass effect compressing nearby structures, which can lead to pain and urinary symptoms. Secondary complications are also possible, such as edema, DVT, and infection, the latter of which is often managed with drainage and antibiotics [4, 5]. Nevertheless, fluid collections remain common after RARP with RPLND in comparison with the few symptomatic collections that require intervention [2, 6, 7]. Still, symptomatic fluid collections account for a large sum of post operative cost as well as patient burden following RARP, which further emphasizes the need for techniques that try to reduce their incidence. A review of the literature has shown two major approaches to preventing lymphoceles and other fluid collections: peritoneal reabsorption and hemostatics. Techniques that focus on peritoneal reabsorption typically involve creating openings or a flap with the peritoneum, often called fenestrations, allowing fluid collections to be reabsorbed. Pose et al, demonstrated this technique in open radical prostatectomies, finding a difference in lymphocele incidence between the fenestration cohort (N = 307) and non-fenestration (N = 1206) cohorts of 6.8% vs 13.9% (p = 0.001) [8]. Likewise, an early randomized control study from Stolzenberg et al described the technique in laparoscopic extraperitoneal radical prostatectomy, finding a significant reduction in the incidence of lymphoceles (p < 0.001) as well as a reduction in symptomatic lymphocele incidence from 14% to 0% [9]. These techniques are nevertheless limited by gravity and the peritoneum’s ability to heal closed, thereby eliminating the channel from prostatectomy bed to peritoneum for the drainage of fluid collections. Hemostatic techniques generally involve using sealants, clips, bipolar energy, or other hemostatic techniques as an attempt to close the lymphatic channels that are disturbed during PLND, theoretically preventing fluid accumulations from forming [10]. Buelens et al demonstrated in a randomized control trial of 100 patients that the use of a hemostatic pad could result in significantly reduced lymphocele incidence, though a more recent study of a next generation hemostatic patch was underpowered to achieve similar significance [11, 12]. Similarly, attempts at utilizing various hemostatic matrices or powders appear to trend towards impactful reductions in collections after RARP, but larger studies are needed to definitively prove a benefit [13, 14]. A recent meta-analysis did attempt to cross between these two realms, comparing outcomes of all major interventions, still finding that peritoneal fenestration had the lowest risk of patients developing lymphoceles (OR 0.14 [0.04, 0.50], p = 0.003) [15]. Ultimately, peritoneal fenestration appears superior in reducing the incidence of fluid collections after RARP, but there remains evidence that hemostatics could be of great use in achieving this goal. Our institution previously used a technique to reduce the rate of fluid collections by combining the use of peritoneal windows with the placement of an abdominal binder postoperatively and successfully achieved a > 50% reduction in fluid collection incidence, decreasing the need for intervention [16]. Understanding where there is opportunity to improve upon the peritoneal window technique as well as the evidence for the role of hemostatics in symptomatic fluid collection prevention, two surgeons at our institution have combined the use of peritoneal reabsorption and the use of a hemostatic mesh, Surgicel. This is the first reported use of a hemostatic agent being used to keep peritoneal windows open for continuous fluid collection wicking and reabsorption within the peritoneum. Materials and Methods The institution’s IRB-approved prostate cancer database was used to identify 467 patients who underwent SP RARP at an academic institution by two surgeons between January 2021 and September 2025. Inclusion criteria were all patients who had documented surgical technique and 30-day follow-up. Exclusion criteria were incomplete operative or follow-up records. No patients meeting inclusion criteria were excluded, and the full eligible cohort was included in analysis. Patients were stratified into cohorts based on surgical technique for prevention of postoperative fluid collection: (1) development of peritoneal window (PW), (2) development of peritoneal window with novel Surgicel (S) hemostatic agent approach, and (3) neither (control). Techniques were carried out as follows: The peritoneal window technique was carried out after performing urethrovesical anastomosis and completion of the pelvic lymph node dissection. An incision was made lateral to the median umbilical ligament to enter the peritoneum laterally. The incision was carried posteriorly to the iliacs and measured at least 4cm. For the novel Surgicel technique, instead of making a peritoneal incision, the peritoneum was bluntly opened with a finger to create an opening approximately 4cm in diameter. This was done after completion of the procedure and undocking of the robot. A long strip of Surgicel is then cut into a Y-shape halfway to the midline, the central limb is placed into the peritoneal cavity, and the lateral limbs placed into the extraperitoneal spaces bilaterally. In this way, the mesh serves as a continuous channel between the prostatic bed and peritoneum for continuous wicking of fluid. See Fig. 1 and Fig. 2 . The primary outcome for this study was the incidence of symptomatic fluid collections. The secondary outcome was the incidence of any fluid collection (symptomatic or asymptomatic). Patient follow up data was reviewed for the incidence of postoperative fluid collections, and symptomatic collections were defined as having lower abdominal/pelvic pain, worsening urgency/frequency, or fever. Asymptomatic collections identified during workup for other unrelated medical concerns were also documented. For the full cohort, immediately after the procedure, an abdominal binder was placed on each patient and was removed 48 hours later. The decision to leave abdominal drains in place was surgeon dependent with no drain being placed for longer than 23 hours. Due to low n and event rates close to 0, precision of point estimates was assessed with Agresti-Coull 95% confidence intervals. Group comparisons were made with Kruskal-Wallis rank sum test and Fisher’s exact test. Results Patient characteristics are depicted in Table 1 . Cohorts were defined as follows: peritoneal window (PW), peritoneal window with Surgicel (S), and neither (control). Across groups, there was no significant difference in age distribution or prostate size. There was overall a wide range of BMI across the cohorts from 12.2 to 50.4 kg/m 2 . Table 1 Baseline characteristics of patients who underwent RARP in the PW, S, and control cohorts. Characteristic Peritoneal Window (PW), N = 195 Neither (Control), N = 195 Surgicel (S), N = 77 p-value Age , years 0.49 1 Mean (SD) 62 (7) 61 (7) 61 (7) Median (IQR) 62 (57, 68) 62 (57, 67) 62 (57, 66) Range 42, 77 41, 79 44, 75 BMI , kg/m 2 0.039 1 Mean (SD) 29.0 (4.8) 27.8 (4.2) 28.8 (5.7) Median (IQR) 28.5 (26.1, 31.3) 27.4 (25.1, 30.1) 27.6 (25.0, 30.2) Range 12.2, 45.0 19.5, 41.4 18.6, 50.4 Prostate size , cc 0.49 1 Mean (SD) 41 (16) 39 (15) 42 (18) Median (IQR) 39 (28, 49) 37 (29, 46) 37 (29, 50) Range 13, 90 10, 89 18, 105 Missing 25 1 17 1 Kruskal-Wallis rank sum test 2 Fisher’s exact test The distribution of LND templates varied significantly (p < 0.001). Extended dissection occurred in 0.5% of the PW cohort, 6.7% of the control cohort, and 0% of the S cohort. Standard templates were performed in 90%, 82%, and 92%, respectively. Lymph nodes were not assessed in 7.2%, 11%, and 6.5% of patients, respectively. There were statistically significant differences regarding the number of lymph nodes removed (medians 3.0 [2.0–5.0] PW, 4.0 [2.0–8.0] control, 3.0 [2.0–5.0] S; p = 0.024) but lymph node involvement was rare (0 nodes in 98%, 98%, and 100%; p = 0.97). Operating time was shortest in the S cohort (median 105 minutes [26]) and longest in the control cohort (median 132 minutes [83]; p < 0.001). Hospital stay complications were infrequent overall with 10 (5.1%) Grade I complications occurring in the N cohort but none in the PW and S cohorts (p = 0.067). Thirty-day complications were uncommon and comparable with Grade III/IIIa complications occurring in 3 (1.5%) of the PW cohort, 4 (2.1%) of the control cohort, and 0 patients in the S cohort (p = 0.067 for all 30-day complications). The incidence of fluid collection was low across all techniques and did not differ significantly overall (Fisher’s exact p = 0.19). In the PW group, 4 patients experienced a fluid collection (2.1%, 95% CI 0.6–5.3%). In the control cohort, 11 patients had a collection (5.6%, 95% CI 3.1–9.9%). In the S group, 3 patients had a collection (3.9%, 95% CI 0.9–11.3%). Although the control approach showed a numerically higher incidence compared to the PW cohort (difference = 3.5%; relative risk = 2.7), the confidence intervals overlapped suggesting no significant difference. See Table 2 . Table 2 Cohort data regarding lymph node dissection, hospital stay complications, 30-day complications, and fluid collections after RARP. Characteristic Peritoneal Window (PW), N = 195 Neither (Control), N = 195 Surgicel (S), N = 77 p-value LN Template , n (%) < 0.001 2 Extended 1 (0.5) 13 (6.7) 0 (0) NX 14 (7.2) 22 (11) 5 (6.5) Standard 175 (90) 160 (82) 71 (92) Unknown 5 (2.6) 0 (0) 1 (1.3) Number of LN taken 0.024 1 Mean (SD) 4.3 (3.4) 6.2 (5.7) 3.8 (2.5) Median (IQR) 3.0 (2.0, 5.0) 4.0 (2.0, 8.0) 3.0 (2.0, 5.0) Range 1.0, 28.0 0.0, 33.0 0.0, 14.0 Unknown 14 23 4 Number of nodes involved , n (%) 0.97 2 0 178 (98) 169 (98) 71 (100) 1 2 (1.1) 1 (0.6) 0 (0) 2 1 (0.6) 1 (0.6) 0 (0) 3 0 (0) 1 (0.6) 0 (0) Unknown 14 23 6 Operating Time < 0.001 1 Mean (SD) 124.9 (40.2) 144.9 (52.9) 108.4 (22.9) Median (IQR) 119 (53) 132 (85) 106 (29) Range 24, 284 72, 308 60, 171 Hospital Complications , n (%) 0.067 2 Grade I 0 (0) 10 (5.1) 0 (0) Grade II 0 (0) 0 (0) 0 (0) Grade III 0 (0) 0 (0) 0 (0) Grade IIIa 0 (0) 0 (0) 0 (0) None 195 (100) 185 (95) 77 (100) 30-Day Complications , n (%) 0.068 2 Grade I 0 (0) 2 (1.0) 0 (0) Grade II 0 (0) 2 (1.0) 3 (3.9) Grade III 2 (1.0) 4 (2.1) 0 (0) Grade IIIa 1 (0.5) 0 (0) 0 (0) None 192 (98) 187 (96) 74 (96) Fluid Collections , n (%) 4 (2.1) 11 (5.6) 3 (3.9) 0.19 2 1 Kruskal-Wallis rank sum test 2 Fisher’s exact test Among patients who developed a fluid collection (PW N = 4, Control N = 11, S N = 3), the type of collection was similar across PW (50% lymphocele vs 50% pelvic fluid collection), control (55% lymphocele vs 45% pelvic fluid collection), and S (33% lymphocele vs 67% pelvic fluid collection; Fisher p > 0.99) cohorts. Symptomatic presentation did differ significantly with 100% (4/4) in the PW cohort and 91% (10/11) in the control cohort, compared to 0% in the S cohort (p = 0.005). Time from surgery to complication was not significantly different, though it was shortest in the PW cohort (median [IQR] days: PW 19 [13–33], control 29 [19–35], S 24 [13–35]; Kruskal-Wallis p = 0.70). The need for IR drainage was infrequent and similar (75%, 36%, and 0% of collections drained; p = 0.12). Anatomic location distributions were also comparable (p = 0.89), with lateral/bilateral collections being the most common in the PW cohort (50%), control cohort (72%), and S cohort (66%). See Table 3 . Table 3 Data specifying type, location, and management of fluid collection. Characteristic Peritoneal Window (PW), N = 4 Neither (Control), N = 11 Surgicel (S), N = 3 p-value Type of collection , n (%) > 0.99 1 Lymphocele 2 (50) 6 (55) 1 (33) Pelvic fluid collection 2 (50) 5 (45) 2 (67) Symptomatic collections , n (%) 4 (100) 10 (91) 0 (0) 0.005 1 Days till fluid collection 0.70 2 Mean (SD) 26 (25) 36 (29) 24 (22) Median (IQR) 19 (13, 33) 29 (19, 35) 24 (13, 35) Range 5, 62 11, 94 2, 45 Surgical drainage , n (%) 3 (75) 4 (36) 0 (0) 0.12 1 Collection location , n (%) 0.89 1 Anterior 1 (25) 2 (18) 1 (33) Bilateral 0 (0) 4 (36) 1 (33) Lateral 2 (50) 4 (36) 1 (33) Prostate bed 1 (25) 1 (9.1) 0 (0) 1 Fisher’s exact test 2 Kruskal-Wallis rank sum test Discussion Treatment Options There have been previous attempts at employing hemostatic agents to aid in the reduction of fluid collections, especially symptomatic lymphoceles. In 2011, Waldert et al achieved a 78% reduction in symptomatic lymphoceles (3.1% vs 14.5%, p = 0.149) after extraperitoneal RARP using FloSeal hemostatic matrix (N = 32) in the prostatectomy bed compared to the control group (N = 110) [13]. More recently, Gilbert et al utilized Arista unilaterally on 88 patients after RALP with bilateral PLND and identified 5 total lymphoceles on treated sides compared to 9 on untreated sides (5.7% vs 10.2%, p = 0.248) [14]. The former demonstrated a reduction in average cost per patient as a result of fewer and less expensive interventions to manage these collections ( $ 455 vs $ 533) [13]. Both studies were likely underpowered to sufficiently evaluate the use of these hemostatics. The concept of creating peritoneal windows, also known as peritoneal fenestrations, to aid the prevention of lymphoceles and other symptomatic fluid collections is also well-founded in the literature. The peritoneal fenestration technique itself, first described by Stolzenberg et al in 2008 for laparoscopic radical prostatectomy, involved incising the peritoneum from the level of the spermatic cord to the obturator fossa to create a channel for fluid drainage to the peritoneum [9]. This study found an 81% reduction in lymphocele formation using the peritoneal fenestration technique (p < 0.001) with no symptomatic lymphoceles in the treatment arm compared to 14% in the control group. Although several randomized controlled trials have been published for the transperitoneal technique [17–20], there is comparatively less evidence for the extraperitoneal technique. There are studies demonstrating that the extraperitoneal approach is more worrisome for increased risk of fluid collection and lymphocele formation. These studies point to the smaller extraperitoneal space, which lacks the reabsorptive properties of the peritoneum, as the culprit [9, 10, 21]. Furthermore, the smaller size of the retroperitoneal space offers greater potential for symptomatic fluid collection to develop with smaller collections, whereas the peritoneal space is able to accommodate larger fluid collections before they become symptomatic. Nevertheless, there are benefits to be gained from the extraperitoneal approach, such as shorter LOS, reduced postoperative opioid requirement, quicker catheter removal, and lower EBL with similarly low complication rates compared to transperitoneal RARP [22, 23]. Outcomes of novel technique With the national launch of the SP robot in 2019 and its introduction at our institution, there was an opportunity for broader implementation of the extraperitoneal approach in RARP. Anecdotally, we noticed our patients were experiencing an increased incidence of symptomatic lymphoceles and other fluid collections after RARPs. After speaking with high volume surgeons and consulting the literature, our institution implemented the use of peritoneal windows during RARP cases, finding not only confirmation in the control cohort that the rate of fluid collections was high (11/195, 5.6%), but that the use of peritoneal windows could aid in reducing the incidence of these collections. By adding a third arm to this study with the novel Surgicel technique, we sought to target symptomatic collections more specifically and to do so in a more efficient way. We can confidently say now that our anecdotal thought process was correct. We are searching for solutions that are safer, efficient, and improve outcomes the most and will continue to examine our data as new technologies arise as there may be new methods to reduce lymphoceles and other symptomatic fluid collections. The present study found no instances of symptomatic fluid collections in the Surgicel cohort compared to 100% of collections in the peritoneal window cohort and 91% of collections in the control cohort (p = 0.005). This finding speaks to the underlying methodology of this technique, which is to create a bridge that maintains patency between the prostatectomy bed and the peritoneum. Without the ability for fluid collections to cause mass effect in a closed-off space, the opportunity for symptomatic collections to arise is much less likely. Those collections that were discovered in the Surgicel cohort were discovered incidentally with CTs obtained for other indications. The Surgicel cohort also demonstrated a signal towards a reduction in the incidence of both symptomatic and asymptomatic fluid collections together (3.9% vs 5.6%, p = 0.19). The incidence of fluid collections is low in general, however, and a larger multi-institutional study would be beneficial in determining if this trend in fluid collection incidence bears significance for clinical practice. The benefit of this Surgicel technique is multifaceted. First, as was discussed, hemostatic agents have demonstrated to aid in the reduction of lymphocele formation [13, 14]. Both Floseal and Surgicel consist of a gelatin base in combination with thrombin, which serve to both stabilize clot formation at sites of lymphorrhea as well as physically tamponade these sites [13, 24]. Second, the use of a physical bridge is theorized to promote the patency of the peritoneal window, increasing the length of time of viable drainage into the peritoneum. Lastly, this technique is less complex and more time efficient than the technique described in Saxena et al. As opposed to creating a 4cm incision from the medial umbilical ligament to the iliacs after the urethrovesical anastomosis like in the peritoneal window technique, with the Surgicel technique you need only bluntly dissect an opening in the peritoneum after the completion of the case. This reduced complexity is reflected in the median operating time of each cohort, which is 14 minutes shorter in the Surgicel cohort compared to the peritoneal window cohort (medians 106 minutes [29] vs 119 minutes [53]; p < 0.001). Importantly, both of these cohorts had minimal utilization of extended lymph node templates (0 vs 0.5%) which means this could not account for the significant difference in operating time or the differences in outcomes. Such reductions in operating time, along with reductions in symptomatic fluid collections and those requiring drainage, could potentially result in tangible cost benefits in both the short and long terms. Future study would require a specific analysis of cost data to make any definitive claims, however. Overall safety It is important to consider the safety of this novel Surgicel technique. No patients undergoing the Surgicel or peritoneal window techniques experienced any complications during the hospital stay. There were no instances of major 30-day complications in the Surgicel cohort. Although there were three 30-day Clavien-Dindo grade III/IIIa complications (1.5%) in the peritoneal window cohort and four Grade III complications (2.1%) in the control cohort, each of these was due to a fluid collection requiring drainage [25]. It is reasonable to conclude that the novel Surgicel technique is safe and that, in general, the incidence of major complications is low for patients undergoing SP extraperitoneal RARP. Limitations We acknowledge there are limitations to this study. Chiefly, the three arms of this study are not well balanced in terms of sample size. Future research to validate these findings should include larger and equally represented treatment arms. Additionally, while the peritoneal window and control cohorts were comprised of two high-volume robotic surgeons, the Surgicel technique was only implemented by one of these surgeons. The Surgicel cohort occurred later chronologically than the peritoneal window cohort and, as a result, there is the potential for a temporal learning curve to be influencing these results. In fact, the lower median OR times seen in both Surgicel and peritoneal window cohorts compared to the control cohort would indicate there is some skill progression with the SP robot that occurred over time. Nevertheless, both surgeons in the peritoneal window cohort had comparable baseline outcomes prior to the adoption of the novel technique, which we believe should lessen this concern when examining outcomes from the novel technique. Future study should involve the multi-institutional participation of many high-volume surgeons to avoid any concerns regarding the effect of technique vs surgeon skill. Additionally, as in the original paper published by Saxena et al, all patients received an abdominal binder postoperatively. Hypothesized to decrease the potential space between abdominal wall and anterior bladder, this additional intervention could introduce an element of effect modification as we measure the primary outcome of fluid collection. Conclusions This paper demonstrates a novel technique to reduce symptomatic fluid collections following robot-assisted radical prostatectomy. Our findings show that this technique should be widely adopted by surgeons who use the single-port robot with an extraperitoneal approach, and that this technique demonstrates a favorable efficacy and safety profile based on our cohort. Abbreviations BMI: Body mass index CI: Confidence interval DVT: Deep vein thrombosis EBL: Estimated blood loss IQR: Interquartile range IRB: Institutional review board LND: Lymph node dissection PLND: Pelvic lymph node dissection PW: Peritoneal window RARP: Robot-assisted radical prostatectomy S: Surgicel SP: Single-port Declarations Competing Interests Authors Jacob O’Hara, Ahmed Shalaby, Katerina Lembrikova, Sonam Saxena, Laurence Hou, Aisha Kourouma, David Ambinder and Mubashir S. Billah declare they have no financial interests. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc. Ethics Approval: This study received ethics approval with its IRB approval on 4/21/2021 (Pro2020-1293). Consent to Participate: Informed consent was obtained from all individual participants included in this study. Consent to Publish: Consent to publish was obtained from all individuals included in this study. Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution All authors contributed to the study conception and design. Material preparation and data collection were performed by J.O, S.S, A.S, and A.K. Statistical analysis was performed by SG and JO. The first draft of the manuscript was written by JO and AS and all authors commented on previous versions of the manuscript. Figure 1 was provided by MB. Figure 2 was created by MB, MA, JO, and DA. Critical revisions of the manuscript were made by JO, KL, MB, MA, and MS. All authors read and approved the final manuscript. References Keskin MS, Argun ÖB, Öbek C, Tufek I, Tuna MB, Mourmouris P, Erdoğan S, Kural AR (2016) The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection. 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J Robot Surg 19:151. https://doi.org/10.1007/s11701-025-02330-4 Bründl J, Lenart S, Stojanoski G, Gilfrich C, Rosenhammer B, Stolzlechner M, Ponholzer A, Dreissig C, Weikert S, Burger M, May M (2020) Peritoneal Flap in Robot-Assisted Radical Prostatectomy. Dtsch Arztebl Int 117:243–250. https://doi.org/10.3238/arztebl.2020.0243 Gloger S, Ubrig B, Boy A, Leyh-Bannurah S-R, Siemer S, Arndt M, Stolzenburg J-U, Franz T, Oelke M, Witt JH (2022) Bilateral Peritoneal Flaps Reduce Incidence and Complications of Lymphoceles after Robotic Radical Prostatectomy with Pelvic Lymph Node Dissection-Results of the Prospective Randomized Multicenter Trial ProLy. J Urol 208:333–340. https://doi.org/10.1097/JU.0000000000002693 Student V, Tudos Z, Studentova Z, Cesak O, Studentova H, Repa V, Purova D, Student V (2023) Effect of Peritoneal Fixation (PerFix) on Lymphocele Formation in Robot-assisted Radical Prostatectomy with Pelvic Lymphadenectomy: Results of a Randomized Prospective Trial. Eur Urol 83:154–162. https://doi.org/10.1016/j.eururo.2022.07.027 Lebeis C, Canes D, Sorcini A, Moinzadeh A (2015) Novel Technique Prevents Lymphoceles After Transperitoneal Robotic-assisted Pelvic Lymph Node Dissection: Peritoneal Flap Interposition. Urology 85:1505–1509. https://doi.org/10.1016/j.urology.2015.02.034 Danuser H, Di Pierro GB, Stucki P, Mattei A (2013) Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary? BJU Int 111:963–969. https://doi.org/10.1111/j.1464-410X.2012.11681.x Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Moschovas MC, Joseph J, Kim M, Crivellaro S, Nix J, Patel V, Kaouk J (2023) Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology 171:140–145. https://doi.org/10.1016/j.urology.2022.10.001 Chavali JS, Pedraza AM, Soputro NA, Ramos-Carpinteyro R, Mikesell CD, Kaouk J (2024) Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 16:2994. https://doi.org/10.3390/cancers16172994 Ye IB, Thomson AE, Smith RA, Pease TJ, Chowdhury N, Donahue J, Miseo V, Jauregui JJ, Cavanaugh DL, Koh EY, Ludwig SC (2023) FLOSEAL Versus SURGIFLO in Lumbar Surgery: Similar Outcomes, Different Costs in a Matched Cohort Analysis. World Neurosurg 177:e425–e432. https://doi.org/10.1016/j.wneu.2023.06.070 Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 Additional Declarations Competing interest reported. Authors Jacob O’Hara, Ahmed Shalaby, Katerina Lembrikova, Sonam Saxena, Laurence Hou, Aisha Kourouma, David Ambinder and Mubashir S. Billah declare they have no financial interests. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc. Cite Share Download PDF Status: Published Journal Publication published 04 Apr, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 03 Mar, 2026 Reviews received at journal 03 Mar, 2026 Reviews received at journal 27 Feb, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 24 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8951278","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597792961,"identity":"251aff17-7486-4e7e-9a17-3887f2f030a1","order_by":0,"name":"Jacob O'Hara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACxgYGBmYgnQBiP2ZgOECaFmZjorSAAEwLmzRRWpjbDz98XMBgk8c/+/Cz6sKcO3kM7L2PX+B1WE+asfEMhrRiiXNpZrdnbntWzMBz3MwCr5aGHDZpHobDiQ1nGMxu824DMiTS2Azwaul/A9Ey/wz7t2LitMyA2rLhDI8ZM1QL8wP8Wp4B/WKQlrjxDE+xNEhLG88xNnw6GAz7k4EhVmGTOO8M+8bPIC397G3MH/BqaQCRyG4HWsEmgU+LPDZB/LaMglEwCkbBiAMAxkhI7Lja+dcAAAAASUVORK5CYII=","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Jacob","middleName":"","lastName":"O'Hara","suffix":""},{"id":597792965,"identity":"6e1b446d-420b-4d30-8d02-07159768f9d9","order_by":1,"name":"Ahmed Shalaby","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Shalaby","suffix":""},{"id":597792969,"identity":"b3cd206d-67c0-46b3-ae07-75c6c61d331b","order_by":2,"name":"Katerina Lembrikova","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Katerina","middleName":"","lastName":"Lembrikova","suffix":""},{"id":597792976,"identity":"890cea8b-5de9-4eb6-b709-11e26b80d293","order_by":3,"name":"Sonam Saxena","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Sonam","middleName":"","lastName":"Saxena","suffix":""},{"id":597792983,"identity":"2b6cefa1-b009-4dd7-834a-09792312cf1c","order_by":4,"name":"Laurence Hou","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Laurence","middleName":"","lastName":"Hou","suffix":""},{"id":597792985,"identity":"13556d28-4a6b-4534-9fac-6ca08e9e398d","order_by":5,"name":"Aisha Kourouma","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"","lastName":"Kourouma","suffix":""},{"id":597792991,"identity":"ebb5c792-1e46-4827-9c92-bee47a0e5ec2","order_by":6,"name":"David Ambinder","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Ambinder","suffix":""},{"id":597792995,"identity":"5b8904c9-3b00-47f3-bb27-6683636a166e","order_by":7,"name":"Mubashir S. Billah","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mubashir","middleName":"S.","lastName":"Billah","suffix":""},{"id":597793000,"identity":"4a0c9f38-7952-4d4f-a73d-143ab448ce63","order_by":8,"name":"Michael Stifelman","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Stifelman","suffix":""},{"id":597793004,"identity":"a5a28a2b-c710-4d37-b3c3-464ae649213a","order_by":9,"name":"Mutahar Ahmed","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mutahar","middleName":"","lastName":"Ahmed","suffix":""}],"badges":[],"createdAt":"2026-02-24 00:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8951278/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8951278/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-026-03371-z","type":"published","date":"2026-04-04T15:58:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104399489,"identity":"e23b93a3-5122-4dc3-b727-d8ae7c1c70fd","added_by":"auto","created_at":"2026-03-11 12:06:20","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1221277,"visible":true,"origin":"","legend":"\u003cp\u003eAn image demonstrating the long piece of Surgicel mesh after it has been cut into the Y-shape.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8951278/v1/f98ead536f121eb44acdb5ae.jpeg"},{"id":104398996,"identity":"5fc613a0-2bbd-454f-80bd-f1cb13297aa5","added_by":"auto","created_at":"2026-03-11 12:04:26","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":201787,"visible":true,"origin":"","legend":"\u003cp\u003eAn image demonstrating placement of the Y-shaped Surgicel mesh after completion of the prostatectomy. Notice the two “cut ends” placed in the prostatectomy bed and the single distal limb placed through a small opening into the peritoneal cavity.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8951278/v1/5b461dbe6ab2405ae6979ba5.jpeg"},{"id":106343405,"identity":"cb89408e-bf5c-4203-b61e-77ebd0d6ed73","added_by":"auto","created_at":"2026-04-07 16:05:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2375879,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8951278/v1/20af4983-3f40-419c-a4f8-feab784944d7.pdf"}],"financialInterests":"Competing interest reported. Authors Jacob O’Hara, Ahmed Shalaby, Katerina Lembrikova, Sonam Saxena, Laurence Hou, Aisha Kourouma, David Ambinder and Mubashir S. Billah declare they have no financial interests. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc.","formattedTitle":"A Novel Peritoneal Channel Technique Using a Hemostatic Agent to Minimize Symptomatic Fluid Collections After Single-Port Robot-Assisted Radical Prostatectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePost-operative fluid collections are one of the most common complications following robot-assisted radical prostatectomy (RARP). Most commonly, these fluid collections are lymphoceles and usually develop after RARP with pelvic lymph node dissection (PLND), with current literature estimating an incidence of symptomatic lymphoceles to be 2.5\u0026ndash;15.4% [1\u0026ndash;3].\u003c/p\u003e \u003cp\u003eThese fluid collections become symptomatic secondary to mass effect compressing nearby structures, which can lead to pain and urinary symptoms. Secondary complications are also possible, such as edema, DVT, and infection, the latter of which is often managed with drainage and antibiotics [4, 5]. Nevertheless, fluid collections remain common after RARP with RPLND in comparison with the few symptomatic collections that require intervention [2, 6, 7]. Still, symptomatic fluid collections account for a large sum of post operative cost as well as patient burden following RARP, which further emphasizes the need for techniques that try to reduce their incidence.\u003c/p\u003e \u003cp\u003eA review of the literature has shown two major approaches to preventing lymphoceles and other fluid collections: peritoneal reabsorption and hemostatics. Techniques that focus on peritoneal reabsorption typically involve creating openings or a flap with the peritoneum, often called fenestrations, allowing fluid collections to be reabsorbed. Pose et al, demonstrated this technique in open radical prostatectomies, finding a difference in lymphocele incidence between the fenestration cohort (N\u0026thinsp;=\u0026thinsp;307) and non-fenestration (N\u0026thinsp;=\u0026thinsp;1206) cohorts of 6.8% vs 13.9% (p\u0026thinsp;=\u0026thinsp;0.001) [8]. Likewise, an early randomized control study from Stolzenberg et al described the technique in laparoscopic extraperitoneal radical prostatectomy, finding a significant reduction in the incidence of lymphoceles (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as a reduction in symptomatic lymphocele incidence from 14% to 0% [9]. These techniques are nevertheless limited by gravity and the peritoneum\u0026rsquo;s ability to heal closed, thereby eliminating the channel from prostatectomy bed to peritoneum for the drainage of fluid collections.\u003c/p\u003e \u003cp\u003eHemostatic techniques generally involve using sealants, clips, bipolar energy, or other hemostatic techniques as an attempt to close the lymphatic channels that are disturbed during PLND, theoretically preventing fluid accumulations from forming [10]. Buelens et al demonstrated in a randomized control trial of 100 patients that the use of a hemostatic pad could result in significantly reduced lymphocele incidence, though a more recent study of a next generation hemostatic patch was underpowered to achieve similar significance [11, 12]. Similarly, attempts at utilizing various hemostatic matrices or powders appear to trend towards impactful reductions in collections after RARP, but larger studies are needed to definitively prove a benefit [13, 14]. A recent meta-analysis did attempt to cross between these two realms, comparing outcomes of all major interventions, still finding that peritoneal fenestration had the lowest risk of patients developing lymphoceles (OR 0.14 [0.04, 0.50], p\u0026thinsp;=\u0026thinsp;0.003) [15]. Ultimately, peritoneal fenestration appears superior in reducing the incidence of fluid collections after RARP, but there remains evidence that hemostatics could be of great use in achieving this goal.\u003c/p\u003e \u003cp\u003eOur institution previously used a technique to reduce the rate of fluid collections by combining the use of peritoneal windows with the placement of an abdominal binder postoperatively and successfully achieved a\u0026thinsp;\u0026gt;\u0026thinsp;50% reduction in fluid collection incidence, decreasing the need for intervention [16]. Understanding where there is opportunity to improve upon the peritoneal window technique as well as the evidence for the role of hemostatics in symptomatic fluid collection prevention, two surgeons at our institution have combined the use of peritoneal reabsorption and the use of a hemostatic mesh, Surgicel. This is the first reported use of a hemostatic agent being used to keep peritoneal windows open for continuous fluid collection wicking and reabsorption within the peritoneum.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe institution\u0026rsquo;s IRB-approved prostate cancer database was used to identify 467 patients who underwent SP RARP at an academic institution by two surgeons between January 2021 and September 2025. Inclusion criteria were all patients who had documented surgical technique and 30-day follow-up. Exclusion criteria were incomplete operative or follow-up records. No patients meeting inclusion criteria were excluded, and the full eligible cohort was included in analysis. Patients were stratified into cohorts based on surgical technique for prevention of postoperative fluid collection: (1) development of peritoneal window (PW), (2) development of peritoneal window with novel Surgicel (S) hemostatic agent approach, and (3) neither (control). Techniques were carried out as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe peritoneal window technique was carried out after performing urethrovesical anastomosis and completion of the pelvic lymph node dissection. An incision was made lateral to the median umbilical ligament to enter the peritoneum laterally. The incision was carried posteriorly to the iliacs and measured at least 4cm.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFor the novel Surgicel technique, instead of making a peritoneal incision, the peritoneum was bluntly opened with a finger to create an opening approximately 4cm in diameter. This was done after completion of the procedure and undocking of the robot. A long strip of Surgicel is then cut into a Y-shape halfway to the midline, the central limb is placed into the peritoneal cavity, and the lateral limbs placed into the extraperitoneal spaces bilaterally. In this way, the mesh serves as a continuous channel between the prostatic bed and peritoneum for continuous wicking of fluid. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe primary outcome for this study was the incidence of symptomatic fluid collections. The secondary outcome was the incidence of any fluid collection (symptomatic or asymptomatic). Patient follow up data was reviewed for the incidence of postoperative fluid collections, and symptomatic collections were defined as having lower abdominal/pelvic pain, worsening urgency/frequency, or fever. Asymptomatic collections identified during workup for other unrelated medical concerns were also documented. For the full cohort, immediately after the procedure, an abdominal binder was placed on each patient and was removed 48 hours later. The decision to leave abdominal drains in place was surgeon dependent with no drain being placed for longer than 23 hours. Due to low n and event rates close to 0, precision of point estimates was assessed with Agresti-Coull 95% confidence intervals. Group comparisons were made with Kruskal-Wallis rank sum test and Fisher\u0026rsquo;s exact test.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePatient characteristics are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Cohorts were defined as follows: peritoneal window (PW), peritoneal window with Surgicel (S), and neither (control). Across groups, there was no significant difference in age distribution or prostate size. There was overall a wide range of BMI across the cohorts from 12.2 to 50.4 kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients who underwent RARP in the PW, S, and control cohorts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritoneal Window (PW),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;195\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeither (Control),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;195\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgicel (S),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;77\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (57, 68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (57, 67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (57, 66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42, 77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41, 79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44, 75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.0 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.8 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.8 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.5 (26.1, 31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.4 (25.1, 30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.6 (25.0, 30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.2, 45.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.5, 41.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6, 50.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProstate size\u003c/b\u003e, cc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (28, 49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (29, 46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (29, 50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13, 90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10, 89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18, 105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e Kruskal-Wallis rank sum test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e2\u003c/em\u003e Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe distribution of LND templates varied significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Extended dissection occurred in 0.5% of the PW cohort, 6.7% of the control cohort, and 0% of the S cohort. Standard templates were performed in 90%, 82%, and 92%, respectively. Lymph nodes were not assessed in 7.2%, 11%, and 6.5% of patients, respectively. There were statistically significant differences regarding the number of lymph nodes removed (medians 3.0 [2.0\u0026ndash;5.0] PW, 4.0 [2.0\u0026ndash;8.0] control, 3.0 [2.0\u0026ndash;5.0] S; p\u0026thinsp;=\u0026thinsp;0.024) but lymph node involvement was rare (0 nodes in 98%, 98%, and 100%; p\u0026thinsp;=\u0026thinsp;0.97). Operating time was shortest in the S cohort (median 105 minutes [26]) and longest in the control cohort (median 132 minutes [83]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eHospital stay complications were infrequent overall with 10 (5.1%) Grade I complications occurring in the N cohort but none in the PW and S cohorts (p\u0026thinsp;=\u0026thinsp;0.067). Thirty-day complications were uncommon and comparable with Grade III/IIIa complications occurring in 3 (1.5%) of the PW cohort, 4 (2.1%) of the control cohort, and 0 patients in the S cohort (p\u0026thinsp;=\u0026thinsp;0.067 for all 30-day complications).\u003c/p\u003e \u003cp\u003eThe incidence of fluid collection was low across all techniques and did not differ significantly overall (Fisher\u0026rsquo;s exact p\u0026thinsp;=\u0026thinsp;0.19). In the PW group, 4 patients experienced a fluid collection (2.1%, 95% CI 0.6\u0026ndash;5.3%). In the control cohort, 11 patients had a collection (5.6%, 95% CI 3.1\u0026ndash;9.9%). In the S group, 3 patients had a collection (3.9%, 95% CI 0.9\u0026ndash;11.3%). Although the control approach showed a numerically higher incidence compared to the PW cohort (difference\u0026thinsp;=\u0026thinsp;3.5%; relative risk\u0026thinsp;=\u0026thinsp;2.7), the confidence intervals overlapped suggesting no significant difference. \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCohort data regarding lymph node dissection, hospital stay complications, 30-day complications, and fluid collections after RARP. \u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritoneal Window (PW),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;195\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeither (Control),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;195\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgicel (S),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;77\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLN Template\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of LN taken\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (2.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0 (2.0, 8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0 (2.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0, 28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0, 33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0, 14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of nodes involved\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.97\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperating Time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124.9 (40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144.9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.4 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24, 284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72, 308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60, 171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Complications\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30-Day Complications\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.068\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFluid Collections\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e Kruskal-Wallis rank sum test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e2\u003c/em\u003e Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eAmong patients who developed a fluid collection (PW N\u0026thinsp;=\u0026thinsp;4, Control N\u0026thinsp;=\u0026thinsp;11, S N\u0026thinsp;=\u0026thinsp;3), the type of collection was similar across PW (50% lymphocele vs 50% pelvic fluid collection), control (55% lymphocele vs 45% pelvic fluid collection), and S (33% lymphocele vs 67% pelvic fluid collection; Fisher p\u0026thinsp;\u0026gt;\u0026thinsp;0.99) cohorts. Symptomatic presentation did differ significantly with 100% (4/4) in the PW cohort and 91% (10/11) in the control cohort, compared to 0% in the S cohort (p\u0026thinsp;=\u0026thinsp;0.005). Time from surgery to complication was not significantly different, though it was shortest in the PW cohort (median [IQR] days: PW 19 [13\u0026ndash;33], control 29 [19\u0026ndash;35], S 24 [13\u0026ndash;35]; Kruskal-Wallis p\u0026thinsp;=\u0026thinsp;0.70). The need for IR drainage was infrequent and similar (75%, 36%, and 0% of collections drained; p\u0026thinsp;=\u0026thinsp;0.12). Anatomic location distributions were also comparable (p\u0026thinsp;=\u0026thinsp;0.89), with lateral/bilateral collections being the most common in the PW cohort (50%), control cohort (72%), and S cohort (66%). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eData specifying type, location, and management of fluid collection.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritoneal Window (PW),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeither (Control),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgicel (S),\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of collection\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic fluid collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptomatic collections\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDays till fluid collection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.70\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (13, 33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (19, 35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (13, 35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5, 62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11, 94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2, 45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical drainage\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCollection location\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e Fisher\u0026rsquo;s exact test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e2\u003c/em\u003e Kruskal-Wallis rank sum test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Options\u003c/h2\u003e \u003cp\u003eThere have been previous attempts at employing hemostatic agents to aid in the reduction of fluid collections, especially symptomatic lymphoceles. In 2011, Waldert et al achieved a 78% reduction in symptomatic lymphoceles (3.1% vs 14.5%, p\u0026thinsp;=\u0026thinsp;0.149) after extraperitoneal RARP using FloSeal hemostatic matrix (N\u0026thinsp;=\u0026thinsp;32) in the prostatectomy bed compared to the control group (N\u0026thinsp;=\u0026thinsp;110) [13]. More recently, Gilbert et al utilized Arista unilaterally on 88 patients after RALP with bilateral PLND and identified 5 total lymphoceles on treated sides compared to 9 on untreated sides (5.7% vs 10.2%, p\u0026thinsp;=\u0026thinsp;0.248) [14]. The former demonstrated a reduction in average cost per patient as a result of fewer and less expensive interventions to manage these collections (\u003cspan\u003e$\u003c/span\u003e455 vs \u003cspan\u003e$\u003c/span\u003e533) [13]. Both studies were likely underpowered to sufficiently evaluate the use of these hemostatics.\u003c/p\u003e \u003cp\u003eThe concept of creating peritoneal windows, also known as peritoneal fenestrations, to aid the prevention of lymphoceles and other symptomatic fluid collections is also well-founded in the literature. The peritoneal fenestration technique itself, first described by Stolzenberg et al in 2008 for laparoscopic radical prostatectomy, involved incising the peritoneum from the level of the spermatic cord to the obturator fossa to create a channel for fluid drainage to the peritoneum [9]. This study found an 81% reduction in lymphocele formation using the peritoneal fenestration technique (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with no symptomatic lymphoceles in the treatment arm compared to 14% in the control group. Although several randomized controlled trials have been published for the transperitoneal technique [17\u0026ndash;20], there is comparatively less evidence for the extraperitoneal technique.\u003c/p\u003e \u003cp\u003eThere are studies demonstrating that the extraperitoneal approach is more worrisome for increased risk of fluid collection and lymphocele formation. These studies point to the smaller extraperitoneal space, which lacks the reabsorptive properties of the peritoneum, as the culprit [9, 10, 21]. Furthermore, the smaller size of the retroperitoneal space offers greater potential for symptomatic fluid collection to develop with smaller collections, whereas the peritoneal space is able to accommodate larger fluid collections before they become symptomatic. Nevertheless, there are benefits to be gained from the extraperitoneal approach, such as shorter LOS, reduced postoperative opioid requirement, quicker catheter removal, and lower EBL with similarly low complication rates compared to transperitoneal RARP [22, 23].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcomes of novel technique\u003c/h3\u003e\n\u003cp\u003eWith the national launch of the SP robot in 2019 and its introduction at our institution, there was an opportunity for broader implementation of the extraperitoneal approach in RARP. Anecdotally, we noticed our patients were experiencing an increased incidence of symptomatic lymphoceles and other fluid collections after RARPs. After speaking with high volume surgeons and consulting the literature, our institution implemented the use of peritoneal windows during RARP cases, finding not only confirmation in the control cohort that the rate of fluid collections was high (11/195, 5.6%), but that the use of peritoneal windows could aid in reducing the incidence of these collections. By adding a third arm to this study with the novel Surgicel technique, we sought to target symptomatic collections more specifically and to do so in a more efficient way. We can confidently say now that our anecdotal thought process was correct. We are searching for solutions that are safer, efficient, and improve outcomes the most and will continue to examine our data as new technologies arise as there may be new methods to reduce lymphoceles and other symptomatic fluid collections.\u003c/p\u003e \u003cp\u003eThe present study found no instances of symptomatic fluid collections in the Surgicel cohort compared to 100% of collections in the peritoneal window cohort and 91% of collections in the control cohort (p\u0026thinsp;=\u0026thinsp;0.005). This finding speaks to the underlying methodology of this technique, which is to create a bridge that maintains patency between the prostatectomy bed and the peritoneum. Without the ability for fluid collections to cause mass effect in a closed-off space, the opportunity for symptomatic collections to arise is much less likely. Those collections that were discovered in the Surgicel cohort were discovered incidentally with CTs obtained for other indications. The Surgicel cohort also demonstrated a signal towards a reduction in the incidence of both symptomatic and asymptomatic fluid collections together (3.9% vs 5.6%, p\u0026thinsp;=\u0026thinsp;0.19). The incidence of fluid collections is low in general, however, and a larger multi-institutional study would be beneficial in determining if this trend in fluid collection incidence bears significance for clinical practice.\u003c/p\u003e \u003cp\u003eThe benefit of this Surgicel technique is multifaceted. First, as was discussed, hemostatic agents have demonstrated to aid in the reduction of lymphocele formation [13, 14]. Both Floseal and Surgicel consist of a gelatin base in combination with thrombin, which serve to both stabilize clot formation at sites of lymphorrhea as well as physically tamponade these sites [13, 24]. Second, the use of a physical bridge is theorized to promote the patency of the peritoneal window, increasing the length of time of viable drainage into the peritoneum. Lastly, this technique is less complex and more time efficient than the technique described in Saxena et al. As opposed to creating a 4cm incision from the medial umbilical ligament to the iliacs after the urethrovesical anastomosis like in the peritoneal window technique, with the Surgicel technique you need only bluntly dissect an opening in the peritoneum after the completion of the case. This reduced complexity is reflected in the median operating time of each cohort, which is 14 minutes shorter in the Surgicel cohort compared to the peritoneal window cohort (medians 106 minutes [29] vs 119 minutes [53]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Importantly, both of these cohorts had minimal utilization of extended lymph node templates (0 vs 0.5%) which means this could not account for the significant difference in operating time or the differences in outcomes. Such reductions in operating time, along with reductions in symptomatic fluid collections and those requiring drainage, could potentially result in tangible cost benefits in both the short and long terms. Future study would require a specific analysis of cost data to make any definitive claims, however.\u003c/p\u003e\n\u003ch3\u003eOverall safety\u003c/h3\u003e\n\u003cp\u003eIt is important to consider the safety of this novel Surgicel technique. No patients undergoing the Surgicel or peritoneal window techniques experienced any complications during the hospital stay. There were no instances of major 30-day complications in the Surgicel cohort. Although there were three 30-day Clavien-Dindo grade III/IIIa complications (1.5%) in the peritoneal window cohort and four Grade III complications (2.1%) in the control cohort, each of these was due to a fluid collection requiring drainage [25]. It is reasonable to conclude that the novel Surgicel technique is safe and that, in general, the incidence of major complications is low for patients undergoing SP extraperitoneal RARP.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWe acknowledge there are limitations to this study. Chiefly, the three arms of this study are not well balanced in terms of sample size. Future research to validate these findings should include larger and equally represented treatment arms. Additionally, while the peritoneal window and control cohorts were comprised of two high-volume robotic surgeons, the Surgicel technique was only implemented by one of these surgeons. The Surgicel cohort occurred later chronologically than the peritoneal window cohort and, as a result, there is the potential for a temporal learning curve to be influencing these results. In fact, the lower median OR times seen in both Surgicel and peritoneal window cohorts compared to the control cohort would indicate there is some skill progression with the SP robot that occurred over time. Nevertheless, both surgeons in the peritoneal window cohort had comparable baseline outcomes prior to the adoption of the novel technique, which we believe should lessen this concern when examining outcomes from the novel technique. Future study should involve the multi-institutional participation of many high-volume surgeons to avoid any concerns regarding the effect of technique vs surgeon skill. Additionally, as in the original paper published by Saxena et al, all patients received an abdominal binder postoperatively. Hypothesized to decrease the potential space between abdominal wall and anterior bladder, this additional intervention could introduce an element of effect modification as we measure the primary outcome of fluid collection.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis paper demonstrates a novel technique to reduce symptomatic fluid collections following robot-assisted radical prostatectomy. Our findings show that this technique should be widely adopted by surgeons who use the single-port robot with an extraperitoneal approach, and that this technique demonstrates a favorable efficacy and safety profile based on our cohort.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eBMI: Body mass index\u003c/li\u003e\n \u003cli\u003eCI: Confidence interval\u003c/li\u003e\n \u003cli\u003eDVT: Deep vein thrombosis\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEBL: Estimated blood loss\u003c/li\u003e\n \u003cli\u003eIQR: Interquartile range\u003c/li\u003e\n \u003cli\u003eIRB: Institutional review board\u003c/li\u003e\n \u003cli\u003eLND: Lymph node dissection\u003c/li\u003e\n \u003cli\u003ePLND: Pelvic lymph node dissection\u003c/li\u003e\n \u003cli\u003ePW: Peritoneal window\u003c/li\u003e\n \u003cli\u003eRARP: Robot-assisted radical prostatectomy\u003c/li\u003e\n \u003cli\u003eS: Surgicel\u003c/li\u003e\n \u003cli\u003eSP: Single-port\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eAuthors Jacob O\u0026rsquo;Hara, Ahmed Shalaby, Katerina Lembrikova, Sonam Saxena, Laurence Hou, Aisha Kourouma, David Ambinder and Mubashir S. Billah declare they have no financial interests. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics Approval:\u003c/h2\u003e \u003cp\u003eThis study received ethics approval with its IRB approval on 4/21/2021 (Pro2020-1293).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Participate:\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Publish:\u003c/strong\u003e \u003cp\u003eConsent to publish was obtained from all individuals included in this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by J.O, S.S, A.S, and A.K. Statistical analysis was performed by SG and JO. The first draft of the manuscript was written by JO and AS and all authors commented on previous versions of the manuscript. Figure 1 was provided by MB. Figure 2 was created by MB, MA, JO, and DA. Critical revisions of the manuscript were made by JO, KL, MB, MA, and MS. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKeskin MS, Argun \u0026Ouml;B, \u0026Ouml;bek C, Tufek I, Tuna MB, Mourmouris P, Erdoğan S, Kural AR (2016) The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection. BJU Int 118:127\u0026ndash;131. https://doi.org/10.1111/bju.13425\u003c/li\u003e\n\u003cli\u003eOrvieto MA, Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel VR (2011) Incidence of lymphoceles after robot-assisted pelvic lymph node dissection. BJU Int 108:1185\u0026ndash;1190. https://doi.org/10.1111/j.1464-410X.2011.10094.x\u003c/li\u003e\n\u003cli\u003eNovara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg J-U, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Wilson TG (2012) Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 62:431\u0026ndash;452. https://doi.org/10.1016/j.eururo.2012.05.044\u003c/li\u003e\n\u003cli\u003ePloussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, Sulser T, Tewari AK, Eastham JA (2014) Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. 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Int J Urol 18:638\u0026ndash;643. https://doi.org/10.1111/j.1442-2042.2011.02797.x\u003c/li\u003e\n\u003cli\u003ePose RM, Knipper S, W\u0026uuml;rnschimmel C, Tennstedt P, Michl U, Maurer T, Graefen M, Steuber T (2021) Significant reduction of lymphoceles after radical prostatectomy and pelvic lymph node dissection. BJU Int 128:728\u0026ndash;733. https://doi.org/10.1111/bju.15497\u003c/li\u003e\n\u003cli\u003eStolzenburg J-U, Wasserscheid J, Rabenalt R, Do M, Schwalenberg T, McNeill A, Constantinides C, Kallidonis P, Ganzer R, Liatsikos E (2008) Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration. World J Urol 26:581\u0026ndash;586. https://doi.org/10.1007/s00345-008-0327-3\u003c/li\u003e\n\u003cli\u003eLee HJ, Kane CJ (2014) How to minimize lymphoceles and treat clinically symptomatic lymphoceles after radical prostatectomy. Curr Urol Rep 15:445. https://doi.org/10.1007/s11934-014-0445-y\u003c/li\u003e\n\u003cli\u003eBuelens S, Van Praet C, Poelaert F, Van Huele A, Decaestecker K, Lumen N (2018) Prospective Randomized Controlled Trial Exploring the Effect of TachoSil on Lymphocele Formation After Extended Pelvic Lymph Node Dissection in Prostate Cancer. Urology 118:134\u0026ndash;140. https://doi.org/10.1016/j.urology.2018.05.008\u003c/li\u003e\n\u003cli\u003eTeoh JY-C, Liu AQ, Yuen VW-F, Lai FP-T, Yuen SK-K, Chan SY-S, Wong JH-F, Li JK-M, Tam MH-M, Chiu PK-F, Yee SC-H, Ng C-F (2022) Hemopatch to Prevent Lymphatic Leak after Robotic Prostatectomy and Pelvic Lymph Node Dissection: A Randomized Controlled Trial. Cancers (Basel) 14:4476. https://doi.org/10.3390/cancers14184476\u003c/li\u003e\n\u003cli\u003eWaldert M, Remzi M, Klatte T, Klingler HC (2011) FloSeal reduces the incidence of lymphoceles after lymphadenectomies in laparoscopic and robot-assisted extraperitoneal radical prostatectomy. J Endourol 25:969\u0026ndash;973. https://doi.org/10.1089/end.2010.0635\u003c/li\u003e\n\u003cli\u003eGilbert DR, Angell J, Abaza R (2016) Evaluation of Absorbable Hemostatic Powder for Prevention of Lymphoceles Following Robotic Prostatectomy With Lymphadenectomy. Urology 98:75\u0026ndash;80. https://doi.org/10.1016/j.urology.2016.06.071\u003c/li\u003e\n\u003cli\u003eHinojosa-Gonz\u0026aacute;lez DE, Saffati G, Kronstedt S, La T, Chiu C, Wahlstedt E, Jones JA, Kadmon D, Badal J, Taylor JM, Slawin JR (2024) Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression. J Robot Surg 18:177. https://doi.org/10.1007/s11701-024-01918-6\u003c/li\u003e\n\u003cli\u003eSaxena S, Billah MS, Cadiente A, Implicito C, Thiemann D, Brink S, Kourouma A, Sanchez de la Rosa R, Stifelman MD, Ahmed M (2025) Use of peritoneal window and abdominal binder to reduce fluid collection after single-port robotic radical prostatectomy. J Robot Surg 19:151. https://doi.org/10.1007/s11701-025-02330-4\u003c/li\u003e\n\u003cli\u003eBr\u0026uuml;ndl J, Lenart S, Stojanoski G, Gilfrich C, Rosenhammer B, Stolzlechner M, Ponholzer A, Dreissig C, Weikert S, Burger M, May M (2020) Peritoneal Flap in Robot-Assisted Radical Prostatectomy. Dtsch Arztebl Int 117:243\u0026ndash;250. https://doi.org/10.3238/arztebl.2020.0243\u003c/li\u003e\n\u003cli\u003eGloger S, Ubrig B, Boy A, Leyh-Bannurah S-R, Siemer S, Arndt M, Stolzenburg J-U, Franz T, Oelke M, Witt JH (2022) Bilateral Peritoneal Flaps Reduce Incidence and Complications of Lymphoceles after Robotic Radical Prostatectomy with Pelvic Lymph Node Dissection-Results of the Prospective Randomized Multicenter Trial ProLy. J Urol 208:333\u0026ndash;340. https://doi.org/10.1097/JU.0000000000002693\u003c/li\u003e\n\u003cli\u003eStudent V, Tudos Z, Studentova Z, Cesak O, Studentova H, Repa V, Purova D, Student V (2023) Effect of Peritoneal Fixation (PerFix) on Lymphocele Formation in Robot-assisted Radical Prostatectomy with Pelvic Lymphadenectomy: Results of a Randomized Prospective Trial. Eur Urol 83:154\u0026ndash;162. https://doi.org/10.1016/j.eururo.2022.07.027\u003c/li\u003e\n\u003cli\u003eLebeis C, Canes D, Sorcini A, Moinzadeh A (2015) Novel Technique Prevents Lymphoceles After Transperitoneal Robotic-assisted Pelvic Lymph Node Dissection: Peritoneal Flap Interposition. Urology 85:1505\u0026ndash;1509. https://doi.org/10.1016/j.urology.2015.02.034\u003c/li\u003e\n\u003cli\u003eDanuser H, Di Pierro GB, Stucki P, Mattei A (2013) Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary? BJU Int 111:963\u0026ndash;969. https://doi.org/10.1111/j.1464-410X.2012.11681.x\u003c/li\u003e\n\u003cli\u003eAbou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Moschovas MC, Joseph J, Kim M, Crivellaro S, Nix J, Patel V, Kaouk J (2023) Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology 171:140\u0026ndash;145. https://doi.org/10.1016/j.urology.2022.10.001\u003c/li\u003e\n\u003cli\u003eChavali JS, Pedraza AM, Soputro NA, Ramos-Carpinteyro R, Mikesell CD, Kaouk J (2024) Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 16:2994. https://doi.org/10.3390/cancers16172994\u003c/li\u003e\n\u003cli\u003eYe IB, Thomson AE, Smith RA, Pease TJ, Chowdhury N, Donahue J, Miseo V, Jauregui JJ, Cavanaugh DL, Koh EY, Ludwig SC (2023) FLOSEAL Versus SURGIFLO in Lumbar Surgery: Similar Outcomes, Different Costs in a Matched Cohort Analysis. World Neurosurg 177:e425\u0026ndash;e432. https://doi.org/10.1016/j.wneu.2023.06.070\u003c/li\u003e\n\u003cli\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santiba\u0026ntilde;es E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187\u0026ndash;196. https://doi.org/10.1097/SLA.0b013e3181b13ca2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Lymphocele, Radical prostatectomy, Peritoneal window, Single port, Robot-assisted","lastPublishedDoi":"10.21203/rs.3.rs-8951278/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8951278/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eSymptomatic fluid collections are a source of morbidity for patients after single-port (SP) robot assisted radical prostatectomy (RARP). We previously demonstrated a reduction in fluid collections by over 50% using peritoneal windows. This study represents the first reported use of a hemostatic agent to maintain peritoneal window patency, promoting wicking and reabsorption of postoperative fluid collections.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe institution\u0026rsquo;s IRB-approved prostate cancer database was used to identify 467 patients who underwent extraperitoneal SP RARP by two surgeons from January 2021 to September 2025. Patients were stratified into cohorts based on surgical technique for prevention of postoperative fluid collection: (1) peritoneal window, (2) peritoneal window with Surgicel, and (3) neither (control). Symptomatic fluid collections were defined as having lower abdominal/pelvic pain, worsening urgency/frequency, or fever.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 467 patients, symptomatic fluid collections were rare across groups. The Surgicel cohort (n\u0026thinsp;=\u0026thinsp;77) had no symptomatic collections and no drainage procedures, compared to 10 symptomatic cases in the control group (n\u0026thinsp;=\u0026thinsp;195) and 4 in the peritoneal window group (n\u0026thinsp;=\u0026thinsp;195) (p\u0026thinsp;=\u0026thinsp;0.005). Asymptomatic collections occurred in 3 patients from the Surgicel cohort (3.9%), none requiring intervention.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWe demonstrate a novel technique using hemostatic mesh to create a channel from the prostatectomy bed to the peritoneum after extraperitoneal SP RARP. This technique markedly reduced the incidence of symptomatic fluid collections and trends toward the reduction of overall collections. This technique is less complex and more time-efficient than the peritoneal window technique. Surgeons seeking to reduce the incidence of symptomatic fluid collections after extraperitoneal SP RARP should consider this technique.\u003c/p\u003e","manuscriptTitle":"A Novel Peritoneal Channel Technique Using a Hemostatic Agent to Minimize Symptomatic Fluid Collections After Single-Port Robot-Assisted Radical Prostatectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 13:51:55","doi":"10.21203/rs.3.rs-8951278/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-04T00:11:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T20:23:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T16:16:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251295115412446414772439918043137278359","date":"2026-02-27T09:15:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338195451841909210407205748324453217585","date":"2026-02-26T20:41:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333940948803269033807346607194880006070","date":"2026-02-25T02:37:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T20:48:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-24T20:42:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-24T03:43:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-02-24T00:14:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a8a15641-b038-4bf4-a096-a6c1d78fc85d","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:02:08+00:00","versionOfRecord":{"articleIdentity":"rs-8951278","link":"https://doi.org/10.1007/s11701-026-03371-z","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2026-04-04 15:58:42","publishedOnDateReadable":"April 4th, 2026"},"versionCreatedAt":"2026-02-27 13:51:55","video":"","vorDoi":"10.1007/s11701-026-03371-z","vorDoiUrl":"https://doi.org/10.1007/s11701-026-03371-z","workflowStages":[]},"version":"v1","identity":"rs-8951278","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8951278","identity":"rs-8951278","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}