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Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling
Ian M Thompson1, Stephen F Kappa1, Todd M Morgan1
1Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Urologic Oncology
|September 24, 2013
Summary
Electrosurgical devices and stapler devices show similar outcomes for blood loss and safety during radical cystectomy (RC). However, electrosurgical devices are significantly more cost-effective and require fewer additional hemostatic measures.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Radical cystectomy (RC) is a major surgery for bladder cancer associated with substantial blood loss.
- Effective tissue ligation and division are critical during RC to minimize complications.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of mechanical stapler devices versus electrosurgical heat-sealing devices for tissue management during RC.
- To evaluate differences in blood loss, operative time, and device-related costs between the two methods.
Main Methods:
- A prospective, randomized trial involving 80 patients undergoing RC for urothelial bladder carcinoma.
- Patients were randomized to either an Endo GIA Stapler or an Impact LigaSure device for tissue ligation and division.
- Primary outcomes included estimated blood loss, operative time, and device costs; data were analyzed using statistical tests.
Main Results:
- No significant differences were observed in mean estimated blood loss (687 ml vs. 708 ml) or operative time between the electrosurgical and stapler groups.
- Transfusion requirements were similar between the two groups.
- The electrosurgical (LigaSure) group incurred significantly lower device costs ($625.00 vs. $1490.10) and required fewer adjunctive suture ligatures (1.5 vs. 3.0).
Conclusions:
- Electrosurgical and mechanical methods for controlling vascular pedicles during RC are comparable in terms of blood loss, transfusion rates, and safety.
- The electrosurgical LigaSure device offers a significant cost advantage and reduces the need for additional hemostatic measures compared to the GIA Stapler.