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Stapling for prostate pedicle management during robot-assisted radical prostatectomy.

Esther M Wit1, Jeroen De Jong, Cenk Acar

  • 1Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands - witesther@gmail.com.

Minerva Urologica E Nefrologica = the Italian Journal of Urology and Nephrology
|May 28, 2015
PubMed
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Endo GIA™ stapling during robot-assisted radical prostatectomy (RARP) reduced peripheral positive surgical margins (PSMs) without affecting functional outcomes. This technique offers a modest operative time gain but incurs higher material costs.

Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • Prostate pedicle management is critical in robot-assisted radical prostatectomy (RARP) to balance oncological safety (avoiding positive surgical margins - PSMs) and functional outcomes (nerve sparing).
  • Traditional methods include electrocautery and clips, each with potential limitations in achieving both goals effectively.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of using Endo GIA™ stapling for prostate pedicle management during RARP.
  • To compare stapling with conventional methods regarding surgical, oncological, and functional results, as well as costs.

Main Methods:

  • A retrospective comparison of 55 patients undergoing RARP with Endo GIA™ stapling (Group A) versus 100 patients using other pedicle management techniques (Group B).

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  • Groups were matched for key patient and disease characteristics, including age, prostate size, T-stage, Gleason Score, and nerve-sparing (fascia preservation score).
  • Surgical, oncological (PSMs), functional (erectile function, continence), and cost outcomes were analyzed.

    • Main Results:

    • The overall PSM rate was 33% in the stapling group versus 42% in the control group (P=0.251).
    • Peripheral PSMs were significantly lower with Endo GIA™ stapling (4.1% vs. 11.5%, P=0.021), with no PSMs at the staple line.
    • Pedicle dissection time and overall operative time showed a trend towards reduction with stapling, though material costs were higher (€730 vs. control).
    • Erectile function and continence recovery at 12 months were comparable between groups.

    Conclusions:

    • Endo GIA™ stapling is an effective method for prostate pedicle management in RARP, significantly reducing peripheral PSMs.
    • This technique does not compromise functional recovery (erectile function, continence) compared to conventional methods.
    • While offering a modest operative time advantage, the primary drawback is the increased material cost associated with stapling devices.