Prevention of lymphoceles using peritoneal flaps during robotic-assisted radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis.

Objective: The study aims to assess whether the use of a peritoneal flap (PF) during robotic-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) reduces the incidence of lymphoceles compared to the standard surgical approach without a flap. Methods: The review was prospectively registered on PROSPERO (CRD420251052120). A systematic search of PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Google Scholar was performed up to May 2025. Eligible studies were randomised controlled trials (RCTs) or observational studies comparing PF use with the standard surgical technique without the flap during RARP with PLND. Primary outcomes were symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. Secondary outcomes included complications, operative time, blood loss, positive surgical margins and hospital stay. Results: Fourteen studies (six RCTs, eight observational) including 7316 patients were analysed, with 2997 receiving the PF and 4319 receiving the standard technique. PF use was associated with a significantly lower incidence of symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. PF use reduces overall complications without significantly increasing operative time, hospital stay or positive margins. Intraoperative blood loss was slightly lower in the standard group. Conclusions: PF use during RARP with PLND significantly reduces the incidence of lymphoceles and postoperative complications without compromising oncological or perioperative outcomes. These findings support PF use as a safe and effective technique for preventing lymphoceles.