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Technical consideration in radical retropubic prostatectomy: blood loss after ligation of dorsal venous complex
1Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Ligating the deep dorsal venous complex during prostatectomy significantly reduces blood loss and transfusions. Nerve-sparing techniques further decrease transfusion needs in these patients undergoing prostatectomy.
Area of Science:
- Urology
- Surgical Oncology
- Anesthesiology
Background:
- Radical retropubic prostatectomy and bilateral pelvic lymphadenectomy are complex procedures.
- Managing intraoperative blood loss is a critical aspect of patient safety during these surgeries.
Purpose of the Study:
- To compare the effects of ligating the deep dorsal venous complex versus not ligating it on blood loss and transfusion requirements.
- To evaluate the impact of nerve-sparing techniques within the ligation group.
Main Methods:
- A retrospective analysis of 641 patients undergoing radical retropubic prostatectomy and bilateral pelvic lymphadenectomy.
- Patients were divided into two groups: Group 1 (no deep dorsal vein ligation) and Group 2 (deep dorsal vein ligation).
- Group 2 was further divided into subgroups based on whether a nerve-sparing procedure was attempted.
Main Results:
- Group 2 (ligation) showed significantly less estimated intraoperative blood loss (1,020 ml) and blood transfused (1.21 units) compared to Group 1 (1,262 ml and 1.73 units).
- Within Group 2, subgroup 2a (ligation with nerve-sparing) had a significantly lower mean blood transfusion (0.99 units) than subgroup 2b (1.39 units).
- The least blood loss and transfusions were observed in Group 2a (ligation and nerve-sparing).
Conclusions:
- Ligation of the deep dorsal venous complex is an effective method to reduce intraoperative blood loss and transfusion requirements during radical retropubic prostatectomy.
- Combining deep dorsal vein ligation with a nerve-sparing approach further minimizes the need for blood transfusions.
Abstract:
The estimated blood loss and blood transfused in 641 patients undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy were analyzed to compare ligation and nonligation of the deep dorsal venous complex. Group 1 (325 men) had no attempt at deep dorsal vein ligation and group 2 (316) had ligation of the deep dorsal venous complex. Group 2 was subdivided into group 2a-137 men in whom an attempt at a nerve-sparing procedure was made and group 2b-179 in whom no such attempt was made. Estimated intraoperative blood loss was significantly different between the groups: group 1--mean loss 1,262 ml. and group 2--mean loss 1,020 ml. (p less than 0.0001). The amounts of blood transfused intraoperatively were significantly different: group 1-1.73 units and group 2-1.21 units (p less than 0.0002). Intraoperative blood loss was not significantly different between subgroups 2a and 2b but the mean amount of blood transfused intraoperatively was lower in group 2a than in group 2b (0.99 and 1.39 units, respectively p less than 0.02). The greatest amounts of blood lost and transfused were in group 1 (no ligation) and the least amounts were in group 2a (ligation and nerve-sparing), representing highly statistically significant differences (p less than 0.0001).