The use of an endoscopic stapler vs suture ligature for dorsal vein control in laparoscopic prostatectomy: operative outcomes

To identify differences in operative outcome between methods of controlling the dorsal vein complex during laparoscopic prostatectomy, i.e. suture ligature or stapling with an endoscopic stapler (Endopath ETS Flex 45 linear stapler; Ethicon, Cincinnati, OH, USA). In all, 120 patients who had a laparoscopic prostatectomy between January 2005 and October 2006 were assessed; 60 had suture ligature and 60 were treated with the stapler. In a multivariate analysis accounting for baseline patient and disease characteristics, the primary outcome variables evaluated included estimated blood loss (EBL), operative duration and positive margin rates. The baseline demographics were similar between the sutured and stapled groups for age (59.6 vs 60.1 years, P=0.674), body mass index (29.2 vs 28.5 kg/m(2), P=0.237), preoperative prostate-specific antigen level (5.3 vs 5.7 ng/mL, P=0.5), Gleason score (6.4 vs 6.3, P=0.294), clinical stage (77% vs 88% T1c, P=0.052) and preoperative Sexual Health Inventory for Men score (19.4 vs 19.6, P=0.813). Operative measures were not significantly different between the groups for EBL (287 vs 343 mL, P=0.156) or operative duration (234 vs 223 min, P=0.324). Apical margin involvement was also not significantly different (12% vs 7%, P=0.121). The overall positive margin rate (30% vs 18%, P=0.020) and disease volume (22% vs 13% 'extensive', P=0.021) were higher among the sutured group, but on multivariate analysis the overall margin rate was not significantly different. There was no difference between sutured and stapled control of the dorsal vein complex during laparoscopic prostatectomy in EBL, operative duration or positive margin rate.