Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling device.
OBJECTIVE
Radical cystectomy (RC) is associated with significant blood loss and transfusion requirement. We performed a prospective, randomized trial to compare blood loss, operative time, and cost using 2 different and commonly employed approaches to tissue ligation and division during RC: mechanical (stapler device) and electrosurgical (heat-sealing device).


METHODS
Eighty patients undergoing RC for urothelial bladder carcinoma were randomized to use of either an Endo GIA Stapler or Impact LigaSure device for tissue ligation and division. Primary outcomes were blood loss, operative time, and device costs. Data were analyzed with Wilcoxon rank sum test and Welch 2-sample t test.


RESULTS
There were no significant demographic or preoperative differences between the cohorts. Mean estimated blood loss was similar between the electrosurgical (687 ml) and stapler (708 ml) arms (P = 0.850). There were no significant differences between cohorts when comparing operative times or transfusion requirement. There was a significant increase in the mean number of adjunctive suture ligatures used in the stapling device arm (3.0 vs. 1.5, P = 0.047). Total device costs were significantly lower with the LigaSure compared with the GIA Stapler ($625.00 vs. $1490.10, P<0.001). There were no complications attributable to either device.


CONCLUSIONS
This prospective, randomized study demonstrates no significant difference in blood loss, transfusion requirement, or safety between mechanical vs. electrosurgical control of the vascular pedicles. The LigaSure device, however, is significantly less costly than the GIA Stapler and required fewer additional measures for hemostasis.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Ian M
IM
Thompson
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: stephen.kappa@vanderbilt.edu.
Stephen F
SF
Kappa
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Todd M
TM
Morgan
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Daniel A
DA
Barocas
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Carl J
CJ
Bischoff
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Kirk A
KA
Keegan
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Kelly L
KL
Stratton
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Peter E
PE
Clark
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Matthew J
MJ
Resnick
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Joseph A
JA
Smith
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Michael S
MS
Cookson
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Sam S
SS
Chang
D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008026:Ligation / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D013537:Sutures / Q000191:economics; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
Bladder cancer; Blood transfusion; Cystectomy; Surgical blood loss