OBJECTIVES: Radical cystectomy (RC) is associated with significant blood loss and transfusion requirement.
We performed a prospective, randomized trial to compare blood loss, operative time, and cost using 2 different and commonly employed approaches to tissue ligation and division during RC: mechanical (stapler device) and electrosurgical (heat-sealing device).
METHODS AND MATERIALS: Eighty patients undergoing RC for urothelial bladder carcinoma were randomized to use of either an Endo GIA Stapler or Impact LigaSure device for tissue ligation and division. Primary outcomes were blood loss, operative time, and device costs. Data were analyzed with Wilcoxon rank sum test and Welch 2-sample t test.
RESULTS: There were no significant demographic or preoperative differences between the cohorts. Mean estimated blood loss was similar between the electrosurgical (687ml) and stapler (708ml) arms (P = 0.850). There were no significant differences between cohorts when comparing operative times or transfusion requirement. There was a significant increase in the mean number of adjunctive suture ligatures used in the stapling device arm (3.0 vs. 1.5, P = 0.047). Total device costs were significantly lower with the LigaSure compared with the GIA Stapler ($625.00 vs. $1490.10, P< 0.001). There were no complications attributable to either device.
CONCLUSIONS: This prospective, randomized study demonstrates no significant difference in blood loss, transfusion requirement, or safety between mechanical vs. electrosurgical control of the vascular pedicles. The LigaSure device, however, is significantly less costly than the GIA Stapler and required fewer additional measures for hemostasis.
Written by:
Thompson IM 3rd, Kappa SF, Morgan TM, Barocas DA, Bischoff CJ, Keegan KA, Stratton KL, Clark PE, Resnick MJ, Smith JA Jr, Cookson MS, Chang SS. Are you the author?
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Reference: Urol Oncol. 2013 Sep 17. pii: S1078-1439(13)00255-X.
doi: 10.1016/j.urolonc.2013.06.006
PubMed Abstract
PMID: 24054870
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