Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy

Solomon L. Woldu, Trushar Patel, Edan Y. Shapiro, Ari M. Bergman, Ketan K. Badani

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: There are many concerns expressed by urologists performed robotic assisted laparoscopic prostatectomy (RALP) regarding management of the dorsal vein complex (DVC). We sought to examine the influence of delayed DVC ligation versus standard DVC ligation on the apical surgical margin status and other key surgical parameters following RALP. Materials and methods: The Columbia University Urologic Oncology Database was retrospectively reviewed to identify patients who underwent RALP between 2008-2011. Operative records were analyzed to determine whether the DVC was ligated in the 'standard' or 'delayed' manner. The standard group had the DVC ligated prior to the apical dissection; in the delayed group, the DVC was initially transected and subsequently oversewn after completion of the apical dissection. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation to compare positive apical margin rates based on DVC-control technique. Results: A total of 244 patients were identified, including 118 in the standard group and 126 in the delayed group. Estimated blood loss (112 mL versus 122 mL), operative time (132 min versus 126 min), and postoperative continence rates (81% versus 84% at 3 months) were similar between the standard and delayed DVC groups (p = NS). Apical margin status was also similar in the two groups, with 3.4% having a positive surgical margin in the standard DVC ligation arm, and 1.6% having a positive margin in the delayed DVC ligation arm (p = 0.43). Conclusions: Delayed DVC ligation after apical dissection is a safe approach with comparable surgical outcomes during RALP. From a technical standpoint, we feel it allows for improved visualization of the apical dissection and therefore has become standard practice at our institution.

Original languageEnglish (US)
Pages (from-to)7079-7083
Number of pages5
JournalCanadian Journal of Urology
Volume20
Issue number6
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Robotics
Prostatectomy
Ligation
Veins
Dissection
Operative Time
Databases

Keywords

  • Cancer
  • Laparoscopy
  • Malignant disease
  • Prostate
  • Robotics

ASJC Scopus subject areas

  • Urology

Cite this

Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy. / Woldu, Solomon L.; Patel, Trushar; Shapiro, Edan Y.; Bergman, Ari M.; Badani, Ketan K.

In: Canadian Journal of Urology, Vol. 20, No. 6, 01.12.2013, p. 7079-7083.

Research output: Contribution to journalArticle

Woldu, SL, Patel, T, Shapiro, EY, Bergman, AM & Badani, KK 2013, 'Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy', Canadian Journal of Urology, vol. 20, no. 6, pp. 7079-7083.
Woldu, Solomon L. ; Patel, Trushar ; Shapiro, Edan Y. ; Bergman, Ari M. ; Badani, Ketan K. / Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy. In: Canadian Journal of Urology. 2013 ; Vol. 20, No. 6. pp. 7079-7083.
@article{309c3225329042b4a668f66f47103f77,
title = "Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy",
abstract = "Introduction: There are many concerns expressed by urologists performed robotic assisted laparoscopic prostatectomy (RALP) regarding management of the dorsal vein complex (DVC). We sought to examine the influence of delayed DVC ligation versus standard DVC ligation on the apical surgical margin status and other key surgical parameters following RALP. Materials and methods: The Columbia University Urologic Oncology Database was retrospectively reviewed to identify patients who underwent RALP between 2008-2011. Operative records were analyzed to determine whether the DVC was ligated in the 'standard' or 'delayed' manner. The standard group had the DVC ligated prior to the apical dissection; in the delayed group, the DVC was initially transected and subsequently oversewn after completion of the apical dissection. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation to compare positive apical margin rates based on DVC-control technique. Results: A total of 244 patients were identified, including 118 in the standard group and 126 in the delayed group. Estimated blood loss (112 mL versus 122 mL), operative time (132 min versus 126 min), and postoperative continence rates (81{\%} versus 84{\%} at 3 months) were similar between the standard and delayed DVC groups (p = NS). Apical margin status was also similar in the two groups, with 3.4{\%} having a positive surgical margin in the standard DVC ligation arm, and 1.6{\%} having a positive margin in the delayed DVC ligation arm (p = 0.43). Conclusions: Delayed DVC ligation after apical dissection is a safe approach with comparable surgical outcomes during RALP. From a technical standpoint, we feel it allows for improved visualization of the apical dissection and therefore has become standard practice at our institution.",
keywords = "Cancer, Laparoscopy, Malignant disease, Prostate, Robotics",
author = "Woldu, {Solomon L.} and Trushar Patel and Shapiro, {Edan Y.} and Bergman, {Ari M.} and Badani, {Ketan K.}",
year = "2013",
month = "12",
day = "1",
language = "English (US)",
volume = "20",
pages = "7079--7083",
journal = "The Canadian journal of urology",
issn = "1195-9479",
publisher = "Canadian Journal of Urology",
number = "6",

}

TY - JOUR

T1 - Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy

AU - Woldu, Solomon L.

AU - Patel, Trushar

AU - Shapiro, Edan Y.

AU - Bergman, Ari M.

AU - Badani, Ketan K.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Introduction: There are many concerns expressed by urologists performed robotic assisted laparoscopic prostatectomy (RALP) regarding management of the dorsal vein complex (DVC). We sought to examine the influence of delayed DVC ligation versus standard DVC ligation on the apical surgical margin status and other key surgical parameters following RALP. Materials and methods: The Columbia University Urologic Oncology Database was retrospectively reviewed to identify patients who underwent RALP between 2008-2011. Operative records were analyzed to determine whether the DVC was ligated in the 'standard' or 'delayed' manner. The standard group had the DVC ligated prior to the apical dissection; in the delayed group, the DVC was initially transected and subsequently oversewn after completion of the apical dissection. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation to compare positive apical margin rates based on DVC-control technique. Results: A total of 244 patients were identified, including 118 in the standard group and 126 in the delayed group. Estimated blood loss (112 mL versus 122 mL), operative time (132 min versus 126 min), and postoperative continence rates (81% versus 84% at 3 months) were similar between the standard and delayed DVC groups (p = NS). Apical margin status was also similar in the two groups, with 3.4% having a positive surgical margin in the standard DVC ligation arm, and 1.6% having a positive margin in the delayed DVC ligation arm (p = 0.43). Conclusions: Delayed DVC ligation after apical dissection is a safe approach with comparable surgical outcomes during RALP. From a technical standpoint, we feel it allows for improved visualization of the apical dissection and therefore has become standard practice at our institution.

AB - Introduction: There are many concerns expressed by urologists performed robotic assisted laparoscopic prostatectomy (RALP) regarding management of the dorsal vein complex (DVC). We sought to examine the influence of delayed DVC ligation versus standard DVC ligation on the apical surgical margin status and other key surgical parameters following RALP. Materials and methods: The Columbia University Urologic Oncology Database was retrospectively reviewed to identify patients who underwent RALP between 2008-2011. Operative records were analyzed to determine whether the DVC was ligated in the 'standard' or 'delayed' manner. The standard group had the DVC ligated prior to the apical dissection; in the delayed group, the DVC was initially transected and subsequently oversewn after completion of the apical dissection. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation to compare positive apical margin rates based on DVC-control technique. Results: A total of 244 patients were identified, including 118 in the standard group and 126 in the delayed group. Estimated blood loss (112 mL versus 122 mL), operative time (132 min versus 126 min), and postoperative continence rates (81% versus 84% at 3 months) were similar between the standard and delayed DVC groups (p = NS). Apical margin status was also similar in the two groups, with 3.4% having a positive surgical margin in the standard DVC ligation arm, and 1.6% having a positive margin in the delayed DVC ligation arm (p = 0.43). Conclusions: Delayed DVC ligation after apical dissection is a safe approach with comparable surgical outcomes during RALP. From a technical standpoint, we feel it allows for improved visualization of the apical dissection and therefore has become standard practice at our institution.

KW - Cancer

KW - Laparoscopy

KW - Malignant disease

KW - Prostate

KW - Robotics

UR - http://www.scopus.com/inward/record.url?scp=84891418747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891418747&partnerID=8YFLogxK

M3 - Article

C2 - 24331354

AN - SCOPUS:84891418747

VL - 20

SP - 7079

EP - 7083

JO - The Canadian journal of urology

JF - The Canadian journal of urology

SN - 1195-9479

IS - 6

ER -