Lymphocele Following Total Laparoscopic Nephrectomy: A Case Report

Abstract

Introduction: Lymphocele of the renal fossa is an uncommon postoperative complication after laparoscopic nephrectomy, particularly when no lymph node dissection has been performed. It may arise from disruption of perihilar lymphatic channels during renal surgery and can mimic other postoperative fluid collections or local recurrence during oncological surveillance. Case Presentation: A 64-year-old male patient with no significant comorbidities underwent total left laparoscopic nephrectomy in December 2024 for a left lower-pole renal mass. The immediate postoperative course was uneventful. Final histopathological examination confirmed clear cell renal cell carcinoma, International Society of Urological Pathology nucleolar grade 2, measuring 6.5 cm, with capsular breach and infiltration of perirenal adipose tissue. Surgical margins were negative, and the final pathological stage was pT3aNx. Ten months after surgery, surveillance abdominal magnetic resonance imaging revealed a well-defined T2-hyperintense cystic lesion measuring 10 cm in the left nephrectomy fossa, without gadolinium enhancement or features suggestive of local tumour recurrence. Ultrasound-guided aspiration yielded 62 mL of clear, yellowish fluid. Biochemical analysis showed a fluid-to-plasma creatinine ratio below 1.0, excluding urinoma, and elevated triglyceride levels consistent with lymphatic fluid. Microbiological cultures were sterile, and cytological examination showed no malignant cells, confirming the diagnosis of lymphocele. Follow-up ultrasound six weeks after aspiration demonstrated complete resolution, and the patient remained asymptomatic. Conclusion: Post-nephrectomy lymphocele should be considered in the differential diagnosis of renal fossa fluid collections detected during postoperative surveillance. Imaging combined with aspirate analysis is essential for diagnosis. Ultrasound-guided aspiration may be effective in selected cases, although continued follow-up is important to detect recurrence.