title: Impact of stapling devices on radical cystectomy: comparative study between low- and high-volume surgeons.
abstract: OBJECTIVE
  To compare effectiveness in terms of blood loss and operative time of stapling devices among surgeons with different levels of surgical volume.
  
  
  METHODS
  We evaluated a group of 29 male patients with invasive bladder cancer who underwent radical cystectomy by two groups of surgeons. The first group included two high-volume surgeons, and the second group two low-volume surgeons. All cystectomies were performed using the multifire autosuture articulated vascular Endo-GIA. We compared patients with a series of 28 patients who had undergone radical cystectomy during the same period using standard technique by the same surgeons. Blood loss was defined as the difference between the hemoglobin at the beginning and at the end of cystectomy.
  
  
  RESULTS
  In the group of high-volume surgeons, the mean operative time was 81.4 +/- 17 minutes and 79.3 +/- 20 minutes for the classical and stapler arm, respectively (P = 0.551). In the low-volume surgeons group, the mean operative time was 114.3 +/- 22 minutes and 92.4 +/- 12 minutes for the two methods (P = 0.003). The mean intraoperative blood loss in the experienced surgeons was 2.3 +/- 0.82 g/dL and 1.49 +/- 0.66 g/dL for the classical and stapler arm, respectively (P = 0.008). In the group of low-volume surgeons, the difference in hemoglobin was 3.02 +/- 0.84 g/dL and 1.91 +/- 0.6 g/dL for the two methods (P = 0.02).
  
  
  CONCLUSIONS
  Stapling devices seem to make cystectomy safer and faster in surgeons with different surgical volumes. The group of low-volume surgeons benefited more.
authors.affiliation: Department of Urology, University of Thessaly School of Medicine, Larissa, Greece. tzorvas@otenet.gr
authors.forename: Vassilios
authors.initials: V
authors.lastname: Tzortzis
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Iraklis C
authors.initials: IC
authors.lastname: Mitsogiannis
authors.forename: Georgios
authors.initials: G
authors.lastname: Moutzouris
authors.forename: Anastasios
authors.initials: A
authors.lastname: Karatzas
authors.forename: Angelos
authors.initials: A
authors.lastname: Leventis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mpouzalas
authors.forename: Michael D
authors.initials: MD
authors.lastname: Melekos
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015653:Cystectomy / Q000592:standards* / Q000706:statistics & numerical data*; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D013528:Surgical Staplers; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*