V1277: Technique of Delayed Dorsal Vein Ligation affects Apical Margin Rates during Robotic Radical Prostatectomy
VideoIntroduction and Objectives
The prostatic apex is the most common location for positive surgical margins during robotic assisted laparoscopic prostatectomy. It has been surmised that this positive margin rate at the apical margin occurs during the release of the dorsal vein complex (DVC). We report our experience with two different techniques to ligate the DVC and subsequent positive margin rates at the apex.
A retrospective review of the Columbia Urologic Oncology database identified 118 patients who underwent standard DVC ligation (Group1) and 126 patients who had delayed DVC ligation (Group2) while undergoing RALP. Standard DVC ligation was defined as ligation of the DVC prior to the apical dissection, while delayed DVC ligation represented transection of the DVC prior to ligation and subsequently oversewn. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation done. Post-operative continence was defined as 0 pads per day.
Estimated blood loss (EBL) was similar between both standard and delayed DVC ligation, 188ml vs 126ml, respectively (p>.05). Operative time was also similar, 132 minutes for Group 1 and 126 minutes for Group2 (p>.05). Continence rates at 6 weeks and 3 months was 58% and 81% for patients with standard ligation and 56% and 84% for the delayed dissection group. There was a significant difference with respect to positive apical margins, the rate was 3.5% in patients with standard ligation vs. 1.2% in patients undergoing delayed ligation (p<.05 only="" one="" patient="" in="" group1="" needed="" a="" post="" transfusion.="">
Delayed DVC ligation after apical dissection decreases positive margin rates at the apex during RALP. This technique does not affect operative times, EBL, or post-operative continence rate. This approach has become standard practice at our institution.