Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Controlling the dorsal venous complex during robotic prostatectomy

Can Talug¹, David Y. Josephson¹, Nora H. Ruel², Clayton Lau¹, Mark H. Kawachi¹, Timothy G. Wilson¹

1 Department of Urology, City of Hope, Duarte, California, USA
2 Information Sciences, Division of Biostatistics, City of Hope, Duarte, California, USA
Address correspondence to Dr. Timothy G. Wilson, Department of Urology, City of Hope, 1500 E. Duarte Road, Duarte, CA, 91010 USA

Canadian Journal of Urology 2012, 19(1), 6147-6154.

Abstract

Introduction: The objective of our study was to determine whether the dorsal venous complex (DVC) control technique influences positive apical margins following robotic-assisted laparoscopic radical prostatectomy (RALRP).
Materials and methods: A total of 1058 patients who underwent RALRP at City of Hope between June 2007 and October 2009 were included in the analysis. Endoscopic stapling and suture ligation of the DVC were compared. Positive apical margins were identified and compared based on the DVC control technique. Recurrence probability was estimated using the Kaplan-Meier method, and logistic regression analysis was used to predict the odds of positive apical margins.
Results: Of the 1058 patients, 633 (60%) underwent endoscopic stapling and 425 (40%) had suture ligation. The two groups had similar baseline characteristics including age and body mass index. There was a statistically significant but small difference in preoperative PSA (5.4 ng/mL vs. 5.2 ng/mL, p = 0.03) and operative time (2.8 hours vs. 2.7 hours, p = 0.02) between the groups. However, no significant differences were observed in Gleason score, pathologic stage, or overall positive margin rates. Positive apical margins were found in 39 (6%) and 27 (6%) patients in the stapling and suture groups, respectively. Multivariate analysis showed that higher pathologic stage and final Gleason score were significantly associated with increased risk of positive apical margins.
Conclusions: During RALRP, there is no significant difference in the rate of positive apical margins when the DVC is controlled using either endoscopic stapling or suture ligation. However, patients with higher pathologic stage and final Gleason score are at increased risk for positive apical surgical margins.

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