Stapling for prostate pedicle management during robot assisted radical prostatectomy

Prostate pedicle management is a crucial step during robot assisted radical prostatectomy (RARP). Wide excision of prostate pedicle may be required to avoid positive surgical margins (PSMs) whereas preservation of neurovascular bundles requires resection close on the prostate. We studied Endo GIA stapling of prostate pedicle during RARP.

Retrospectively the outcome of 55 men who underwent RARP with Endo GIA stapling (45mm Echelon Ethicon, group A) of the pedicle were compared with 100 men where another method for prostate pedicle management (mono- and bipolar electrocautery, Hem-o-Lock clips or titanium 10 mm clips, group B) was used. Both groups were matched for age, prostate size, clinical T-stage, Gleason score and fascia preservation (FP) score (as a measure of nerve sparing). Surgical, oncological, functional outcome factors and costs were compared.

The overall PSM rate was 33% in group A and 42% in group B (p=0,251). None of the cases had PSMs at the location of staples. PSMs with Endo GIA stapler at the periphery of the prostate were less frequent than in control group (4,1% vs 11,5%; p=0,021). Median pedicle dissection time (7,8 (3,1- 15,1) min vs 10,5 (5,8-28,3) min; p=0,0001) and median operative time for RARP combined with lymphadenectomy (114 (70-129) min vs 120 (67-200) min; p=0,043) tended to be shorter compared to group B. Erectile function and continence recovery at 12 months were comparable for both groups. Material costs for stapling (€730) were higher compared to variable costs in control group.

Pedicle stapling during RARP reduced peripheral PSMs. It did not compromise functional results, provided a modest operation time gain for pedicle dissection, but is more expensive.

Minerva Urol Nefrol. 2015 May 27. [Epub ahead of print]

Wit E1, De Jong J, Acar C, Van Muilekom E, Tillier C, De Blok W, Van Der Poel H.

Dept. Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands