Endoscopic stapler for the deep venous complex (DVC) control during Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP).
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.
BACKGROUND: To evaluate the effects of DVC stapling on continence return, perioperative blood loss, surgical margins and postoperative complications in patients undergoing robotic assisted laparoscopic radical prostatectomy (RALRP).
METHODS: Four hundred sixty one 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 2 groups: in group A (223 patients) a linear thin/vascular stapler was used for DVC control and group B (238 patients) where suture ligature without skeletonization of DVC was used.
RESULTS: 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). Less patients in group A had bladder neck preservation (15.2% v/s 69.7%; p<0.001). Operative time and EBL were higher in Group A (<0.001). Positive apical margins was found in 5.9% of the group A patients v/s 2.5% in group B (p=0.072). No differences were found between the groups in terms of postoperative blood loss, postoperative complications and Gleason Score. Continence recorded at 4 months, ≤ 1 year and >1 year follow-up visits was significantly different between the 2 groups (p<0.05). Logistic regression analysis showed BN preservation (positive association), prostate volume (inverse association) and clinical stage 2 a-b (inverse association) as a strong predictors of ≤ 4 months continence (p>0.05), while only BN preservation and prostate volume remained predictors of ≤1year and >1 year continence.
DVC stapling can contribute to early and late recovery of continence. However, this technique has prolong operative time and higher perioperative estimated blood loss comparing with suture ligature of DVC. This procedure can also compromise oncologic effectiveness.