title: New retractor facilitates exposure of the vascular pedicles in Chinese men with complex pelvis during radical cystectomy.
abstract: OBJECTIVE
  To evaluate the surgical instrument, the double-slice retractor of pelvis (DBR), for the division of the vascular pedicles from the bladder and prostate in male patients with complex pelvis during radical cystectomy.
  
  
  METHODS
  Radical cystectomy was performed on 140 male patients (all cases body mass index >28 kg/m(2), 29 cases having undergone partial cystectomy) with bladder cancer. With the aid of the double-slice retractor to expose vascular pedicles from the bladder and prostate, 80 radical cystectomies were performed. The others were treated as the control.
  
  
  RESULTS
  The double-slice retractor provided excellent exposure for the division of vascular pedicles from the bladder and prostate. The handling of the vascular pedicles from the bladder and prostate became easier and safer without unnecessary bleeding and injury in the rectum. In double-slice retractor and control groups, the operative time to handle the vascular pedicles during radical cystectomy in the double-slice retractor group was 12.2 ± 1.4 min compared with 22.6 ± 3.4 min for the control group (P < 0.05), and the blood loss was 30.3 ± 2.2 ml compared with 50.2 ± 4.5 ml (P < 0.05). For the whole radical cystectomy procedure, the operative time lasted 72.1 ± 9.2 min in the double-slice retractor group compared with 85.7 ± 6.8 min for the control group (P < 0.05), the whole blood loss was reduced to 340.3 ± 12.7 ml from 410.1 ± 11.4 ml in the control group (P < 0.05). And the rate of transfusion was geared down to 10% in the double-slice retractor group from 25% in the control (P < 0.05).
  
  
  CONCLUSIONS
  The use of the double-slice retractor for the exposure of vascular pedicles from the bladder and prostate is simple and effective in male patients with complex pelvis during radical cystectomy. We have devised a promising surgical instrument for the exposure of vascular pedicles.
authors.affiliation: Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Changwen
authors.initials: C
authors.lastname: Zhang
authors.forename: Ranlu
authors.initials: R
authors.lastname: Liu
authors.forename: Baomin
authors.initials: B
authors.lastname: Qiao
authors.forename: Baojie
authors.initials: B
authors.lastname: Ma
authors.forename: Kuo
authors.initials: K
authors.lastname: Yang
authors.forename: Yong
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000368:Aged; D044466:Asian People; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015992:Body Mass Index; D002681:China; D015653:Cystectomy / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications; D061646:Operative Time; D010388:Pelvis / Q000601:surgery; D013525:Surgical Instruments; D001743:Urinary Bladder / Q000098:blood supply*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000295:instrumentation*