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Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes.
Eur Urol. 2011 Feb; 59(2):235-43.EU

Abstract

BACKGROUND

Apical dissection and control of the dorsal vein complex (DVC) affects blood loss, apical positive margins, and urinary control during robot-assisted laparoscopic radical prostatectomy (RALP).

OBJECTIVE

To describe technique and outcomes for athermal DVC division followed by selective suture ligation (DVC-SSL) compared with DVC suture ligation followed by athermal division (SL-DVC).

DESIGN, SETTINGS, AND PARTICIPANTS

Retrospective study of prospectively collected data from February 2008 to July 2010 for 303 SL-DVC and 240 DVC-SSL procedures.

SURGICAL PROCEDURE

RALP with comparison of DVC-SSL prior to anastomosis versus early SL-DVC prior to bladder-neck dissection.

MEASUREMENTS

Blood loss, transfusions, operative time, apical and overall positive margins, urine leaks, catheterization duration, and urinary control at 5 and 12 mo evaluated using 1) the Expanded Prostate Cancer Index (EPIC) urinary function scale and 2) continence defined as zero pads per day.

RESULTS AND LIMITATIONS

Men who underwent DVC-SSL versus SL-DVC were older (mean: 59.9 vs 57.8 yr, p<0.001), and relatively fewer white men underwent DVC-SSL versus SL-DVC (87.5% vs 96.7%, p<0.001). Operative times were also shorter for DVC-SSL versus SL-DVC (mean: 132 vs 147 min, p<0.001). Men undergoing DVC-SSL versus SL-DVC experienced greater blood loss (mean: 184.3 vs 175.6 ml, p=0.033), and one DVC-SSL versus zero SL-DVC were transfused (p=0.442). Overall (12.2% vs 12.0%, p=1.0) and apical (1.3% vs 2.7%, p=0.361) positive surgical margins were similar for DVC-SSL versus SL-DVC. Although 5-mo postoperative urinary function (mean: 72.9 vs 55.4, p<0.001) and continence (61.4% vs 39.6%, p<0.001) were better for DVC-SSL versus SL-DVC, 12-mo urinary outcomes were similar. In adjusted analyses, DVC-SSL versus SL-DVC was associated with shorter operative times (parameter estimate [PE]±standard error [SE]: 16.84±2.56, p<0.001), and better 5-mo urinary function (PE±SE: 19.93±3.09, p<0.001) and continence (odds ratio 3.39, 95% confidence interval 2.07-5.57, p<0.001).

CONCLUSIONS

DVC-SSL versus SL-DVC improves early urinary control and shortens operative times due to fewer instrument changes with late versus early DVC control.

Authors+Show Affiliations

Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20863611

Citation

Lei, Yin, et al. "Athermal Division and Selective Suture Ligation of the Dorsal Vein Complex During Robot-assisted Laparoscopic Radical Prostatectomy: Description of Technique and Outcomes." European Urology, vol. 59, no. 2, 2011, pp. 235-43.
Lei Y, Alemozaffar M, Williams SB, et al. Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol. 2011;59(2):235-43.
Lei, Y., Alemozaffar, M., Williams, S. B., Hevelone, N., Lipsitz, S. R., Plaster, B. A., Amarasekera, C. A., Ulmer, W. D., Huang, A. C., Kowalczyk, K. J., & Hu, J. C. (2011). Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes. European Urology, 59(2), 235-43. https://doi.org/10.1016/j.eururo.2010.08.043
Lei Y, et al. Athermal Division and Selective Suture Ligation of the Dorsal Vein Complex During Robot-assisted Laparoscopic Radical Prostatectomy: Description of Technique and Outcomes. Eur Urol. 2011;59(2):235-43. PubMed PMID: 20863611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes. AU - Lei,Yin, AU - Alemozaffar,Mehrdad, AU - Williams,Stephen B, AU - Hevelone,Nathanael, AU - Lipsitz,Stuart R, AU - Plaster,Blakely A, AU - Amarasekera,Channa A, AU - Ulmer,William D, AU - Huang,Andy C, AU - Kowalczyk,Keith J, AU - Hu,Jim C, Y1 - 2010/09/15/ PY - 2010/07/25/received PY - 2010/08/26/accepted PY - 2010/9/25/entrez PY - 2010/9/25/pubmed PY - 2011/7/22/medline SP - 235 EP - 43 JF - European urology JO - Eur Urol VL - 59 IS - 2 N2 - BACKGROUND: Apical dissection and control of the dorsal vein complex (DVC) affects blood loss, apical positive margins, and urinary control during robot-assisted laparoscopic radical prostatectomy (RALP). OBJECTIVE: To describe technique and outcomes for athermal DVC division followed by selective suture ligation (DVC-SSL) compared with DVC suture ligation followed by athermal division (SL-DVC). DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective study of prospectively collected data from February 2008 to July 2010 for 303 SL-DVC and 240 DVC-SSL procedures. SURGICAL PROCEDURE: RALP with comparison of DVC-SSL prior to anastomosis versus early SL-DVC prior to bladder-neck dissection. MEASUREMENTS: Blood loss, transfusions, operative time, apical and overall positive margins, urine leaks, catheterization duration, and urinary control at 5 and 12 mo evaluated using 1) the Expanded Prostate Cancer Index (EPIC) urinary function scale and 2) continence defined as zero pads per day. RESULTS AND LIMITATIONS: Men who underwent DVC-SSL versus SL-DVC were older (mean: 59.9 vs 57.8 yr, p<0.001), and relatively fewer white men underwent DVC-SSL versus SL-DVC (87.5% vs 96.7%, p<0.001). Operative times were also shorter for DVC-SSL versus SL-DVC (mean: 132 vs 147 min, p<0.001). Men undergoing DVC-SSL versus SL-DVC experienced greater blood loss (mean: 184.3 vs 175.6 ml, p=0.033), and one DVC-SSL versus zero SL-DVC were transfused (p=0.442). Overall (12.2% vs 12.0%, p=1.0) and apical (1.3% vs 2.7%, p=0.361) positive surgical margins were similar for DVC-SSL versus SL-DVC. Although 5-mo postoperative urinary function (mean: 72.9 vs 55.4, p<0.001) and continence (61.4% vs 39.6%, p<0.001) were better for DVC-SSL versus SL-DVC, 12-mo urinary outcomes were similar. In adjusted analyses, DVC-SSL versus SL-DVC was associated with shorter operative times (parameter estimate [PE]±standard error [SE]: 16.84±2.56, p<0.001), and better 5-mo urinary function (PE±SE: 19.93±3.09, p<0.001) and continence (odds ratio 3.39, 95% confidence interval 2.07-5.57, p<0.001). CONCLUSIONS: DVC-SSL versus SL-DVC improves early urinary control and shortens operative times due to fewer instrument changes with late versus early DVC control. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/20863611/Athermal_division_and_selective_suture_ligation_of_the_dorsal_vein_complex_during_robot_assisted_laparoscopic_radical_prostatectomy:_description_of_technique_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(10)00800-6 DB - PRIME DP - Unbound Medicine ER -