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Skeletonization of DVC followed by ligature with a single stitch during RALRP
LEI YIN, MD1, Aaron C. Weinberg, PHD1, Marcos P. Freire,, PHD1, Sergey K. Kravichick, MD2, Xiangmei Gu, PHD1, Stuart R. Lipsitz, PHD1, Jim C. Hu, MD PHD1.
1BRIGHAM AND WOMEN HOSPITAL, BOSTON, MA, USA, 2BRIGHAM AND WOMEN HOSPITAL, BOSTON, MN, USA.

Introduction and Objective:
To evaluate the effects of a skeletonization DVC followed by ligature with a single stitch on early (≤ 3 months) continence return, perioperative estimated blood loss (EBL), postoperative blood loss, surgical margin status in the apical area and postoperative complications in patients undergoing RALRP.
Methods:
536 patients underwent RALRP through Brigham and Women’s Hospital from 10/14/2005 to 03/20/2009 were included into the study. The Patients were divided into 3 groups :group A (75 patients) - skeletonization of DVC followed by ligature with a single stitch and subsequent section; group B (238 patients) - ligature without skeletonization of DVC; in group C (223 patients) a linear thin/vascular stapler was used for DVC control. For each patient we recorded preoperative, perioperative, postoperative and pathological data variables. Postoperative bleeding was assessed by calculating the difference between recovery room and hospital discharge HCT. Continence was evaluated during follow-up visits 1 and 3 months after catheter removal.
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. In all A group patients bladder neck (BN) was preserved, while neurovascular bundles resection was relatively uncommon in this group (p<0.023). Operative time and EBL were lower in the A group (<0.001). No differences were found between the 3 groups in terms of postoperative blood loss, catheterisation time, postoperative complications and histologic status. As far as early continence rate is concerned, a significant difference was recorded between the groups (p < 0.05). The logistic regression analysis has shown that BN preservation was the strongest predictor of early continence, while ligature without skeletonization of DVC may have a negative impact on early continence recovery.

Conclusions:

The skeletonization of deep venous complex (DVC) followed by ligature can contribute to early recovery of continence, decrease operative time and perioperative blood loss. This technique is especially effective when used with BN preservation.


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