Skeletonization of DVC followed by ligature with a single stitch during RARP: its role in early continence recovery.
Sergey Kravchick, MD1, Stephen Williams, MD1, Ronit Peled, PhD2, Marcos Paulo Freire, MD1, Lei Yin, MD1, Aaron C. Weinberg, Ph1, Jim Hu, MD1.
1Brigham and Women's Hospital, Boston,, MA, USA, 2Health Systems Management Research, Talmey Yaffe, Israel.
To evaluate the effects of skeletonization of the deep venous complex (DVC) followed by suture ligature with a single stitch on early (≤ 4 months) continence return, perioperative blood loss, surgical margins and postoperative complications in patients undergoing robotic assisted laparoscopic radical prostatectomy (RALRP).
Five hundred thirty six patients who underwent RALRP from 14/10/2005 to 20/03/2009 were included into the study. While the study was retrospective by design, all clinical data were obtained prospectively and entered into a clinical database. Patients were divided into 3 groups: group A (75 patients) underwent skeletonization of DVC followed by suture ligature with a single stitch; group B (238 patients) suture ligature without skeletonization of DVC; and group C (223 patients) where a linear thin/vascular stapler was used for DVC control.
The 3 groups were comparable in terms of age, body mass index (BMI), prostate-specific antigen (PSA) values, Gleason score at biopsy, preoperative and pathological estimated prostate volumes (p >0.05).Group A had 75 (100%) bladder neck preservation and neurovascular bundles preserved in the majority (p<0.023). Operative time and EBL were lower in Group A (<0.001). No differences were found between the groups in terms of postoperative blood loss, postoperative complications and Gleason Score. Continence recorded at 4 month follow-up was significantly different between the 3 groups (74.2%, 61.4%, and 71.3%; p<0.05). Logistic regression analysis showed BN preservation (positive association), prostate volume (inverse association) and clinical stage 2a-b (inverse association) as a strong predictors of early continence (p>0.05).
CONCLUSIONS: Skeletonization of the DVC followed by suture ligature can contribute to early continence, decreased operative time and minimal blood loss. This technique is especially effective for early continence return when used with BN preservation.Further follow-up is warranted to evaluate long term success.