Impact Of Stapling Devices On Radical Cystectomy: Comparative StudyBetween Low And High Volume Surgeons

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 19 Apr 2008 - 0:00 PDT

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UroToday.com - This article details the effectiveness of a vascular stapling device in performing a radical cystectomy. The authors determined the blood loss and operative time among high and low-volume surgeons using a multifire autosuture articulated vascular Endo-GIA stapler or standard suturing technique. Twenty-nine male patients with invasive bladder cancer underwent radical cystectomy by two groups of surgeons. The first group included two high-volume surgeons, and the second group two low-volume surgeons. The comparison group was a series of 28 patients who had undergone radical cystectomy during the same period using the standard technique by the same surgeons. Blood loss was the difference between the hemoglobin at the beginning and at the end of cystectomy.

The stapling device did not improve the time it took to complete the cystectomy in the group of high-volume surgeons: the mean operative time was 81.4 +/- 17 minutes and 79.3 +/- 20 minutes for the standard and stapler arm, respectively (P = 0.551). However, the low-volume surgeons benefited significantly from using the stapler: the mean operative time was 114.3 +/- 22 minutes and 92.4 +/- 12 minutes for the standard and stapler arm, respectively (P = 0.003). Both groups had less blood loss when using the stapler, but the benefit was greater with the low-volume surgeons. The mean blood loss for the high-volume surgeons was 2.3 +/- 0.82 g/dL and 1.49 +/- 0.66 g/dL for the standard and stapler arm, respectively (P = 0.008). In the group of low-volume surgeons, the difference in hemoglobin was 3.02 +/- 0.84 g/dL and 1.91 +/- 0.6 g/dL for the standard and stapler arm, respectively (P = 0.02).

The authors concluded that stapling devices make cystectomy safer and faster in surgeons with different surgical volumes, with the group of low volume surgeons benefiting more.

Use of vascular stapling devices was first introduced in 19971, however the cost was significant with 7-10 staples loads used per case. The recent introduction of electrothermal devices to control hemostasis provided a less expensive method of hemostasis, but potential thermal injury to the pelvic nerves is a concern.

1.Yamashita T, Muraishi O, Umeda S and Matsushita T: Radical cystectomy using endoscopic stapling devices: preliminary experience with a simple and reliable technique. J Urol. 157: 263-5, 1997.

Tzortzis V, Gravas S, Mitsogiannis IC, Moutzouris G, Karatzas A, Leventis

Reported by UroToday.com Contributing Editor David P. Wood

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