The effect of the da Vinci® Vessel Sealer on robot-assisted laparoscopic prostatectomy complications Journal Article
| Authors: | Pellegrino, F.; Tin, A. L.; Sjoberg, D. D.; Benfante, N. E.; Weber, R. C.; Porwal, S. P.; Briganti, A.; Montorsi, F.; Eastham, J. A.; Laudone, V. P.; Vickers, A. J. |
| Article Title: | The effect of the da Vinci® Vessel Sealer on robot-assisted laparoscopic prostatectomy complications |
| Abstract: | The da Vinci® Vessel Sealer is a major contributor to the total cost of robot-assisted laparoscopic prostatectomy (RALP). We aimed to assess whether the use of the Vessel Sealer is associated with better surgical outcomes in a population of patients that underwent RALP with lymphadenectomy. We tested whether the use of the Vessel Sealer is associated with the development of lymphocele and/or other surgical outcomes. Most surgeons used the Vessel Sealer in almost all or almost no patients. Thus, to avoid the potential confounding variable of surgeon skill, we performed the initial analyses using data from a single surgeon who changed practice over time, and then using the entire population. Overall, the Vessel Sealer was used in 500 (36%) RALPs. Surgeon 1 performed 492 surgeries, and used the Vessel Sealer in 191 (39%). The Vessel Sealer was not associated with better surgical outcomes in patients operated on by Surgeon 1. The odds ratio for development of lymphocele was 1.95 (95% confidence interval [CI] 0.57–6.75). In the entire population, use of the sealer was significantly associated with a very small reduction of blood loss (22 cc, CI 13–30) but with a 32-min increase in the operating room time (CI 26–37). Use of the Vessel Sealer will have, at best, a very small effect on RALP outcomes that is of highly questionable relevance given its cost. In light of these results, the Vessel Sealer will only be used at our institution in the context of clinical trials. © 2023, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature. |
| Keywords: | adult; controlled study; treatment outcome; middle aged; major clinical study; outcome assessment; lymph node dissection; laparoscopy; lymphadenectomy; prostate specific antigen; bleeding; prostate cancer; confidence interval; length of stay; prostatectomy; prostate biopsy; operation duration; surgeon; urology; blood transfusion; outcome; complications; robotics; hospital readmission; outcomes; prostate cancers; diseases; digital rectal examination; surgical outcome; complication; population statistics; lymphocele; prostate volume; confounding variable; procedures; robot-assisted laparoscopic prostatectomy; cauterization; oxidized regenerated cellulose; ralp; charlson comorbidity index; operative blood loss; humans; human; male; article; robotic surgical procedures; robot assisted surgery; robot-assisted prostatectomy; odd ratios; small reduction; international society of urologic pathologists |
| Journal Title: | Journal of Robotic Surgery |
| Volume: | 17 |
| Issue: | 4 |
| ISSN: | 1863-2483 |
| Publisher: | Springer Verlag London |
| Date Published: | 2023-08-01 |
| Start Page: | 1763 |
| End Page: | 1768 |
| Language: | English |
| DOI: | 10.1007/s11701-023-01595-x |
| PUBMED: | 37043122 |
| PROVIDER: | scopus |
| PMCID: | PMC10852274 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA0098748) acknowledged in PubMed and PDF -- Source: Scopus |
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