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Stapling devices: a technical advance in radical retropubic prostatectomy
Author(s) -
HEATHCOTE P.S.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06085_63.x
Subject(s) - medicine , urinary continence , surgery , blood loss , dissection (medical) , anastomosis , radical retropubic prostatectomy , prostatectomy , urology , urinary system , prostate cancer , cancer , anatomy
This paper describes the use of a ‘thick tissue’, 3.5 ml staple, six row, articulated endoscopic linear cutting stapling gun in Radical Retropubic Prostatectomy (RRP). Patients and Methods: One hundred and ninety four consecutive RRPs performed by a single surgeon were analysed. The first 97 were performed without the stapler and the second 97 performed using an identical surgical technique apart from using the Linear cutting stapler. Results: Groups were of similar age, preop PSA, T stage and Gleason score. There were no staple gun failures. The dorsal venous complex was more safely secured and anastomotic sutures more easily placed especially in the presence of difficult anatomy. Limited division of the puboprostatic ligaments permitted better support of the continence mechanism. Larger pedicles were better secured without distortion of anatomy. Average operative time was reduced from 1.9 to 1.6 h ( P = 0.0005). Average blood loss was reduced from 488 to 380 ml ( P = 0.03). Positive surgical margins in the absence of extra capsular extension were reduced from 9% to 5% mainly due to better apical dissection. Mean time to return of urinary continence (no pads) improved from 4.6 to 4.0 months and urinary continence at twelve months improved from 88 to 92% ( P = NS). Conclusion: The stapler is reliable and easy to use. It improved surgical access and decreased blood loss and operative time improving the overall safety of the operation. It did not compromise cancer control and may improve urinary continence.