Ligasure versus sutures in bladder replacement with Montie ileal neobladder after radical cystectomy

Abstract

Objectives: Electrocoagulation became an indispensable tool for surgeons. Ligasure is a computer-based, temperature-controlled bipolar electrocoagulation system designed as an alternative to suture ligatures, staplers, hemoclips and ultrasonic coagulators for legating vessels and tissue bundles. Our aim was to analyse the procedure time and intraoperative blood loss of the ileal neobladder in a series of 30 highly selected patients.

Patients and methods: From March 1999 to May 2002, 30 patients (all men), 47 to 74 years old (mean age 57) with good performance status (American Society of Anesthesiology score 1 and 2) underwent radical cystectomy for bladder cancer and Montie ileal neobladder reconstruction, using standard surgical technique, with the exception of 15 patients that the Ligasure device was used for haemostasis.

Results: Procedure time was significantly less in the Ligasure arm 170 minutes (range: 150 min - 200 min ) versus 220 minutes (range: 160 min - 250 min) in the suture arm (p < 0.001). Blood loss was significantly less in the Ligasure arm an average 849 cc (range: 820 cc - 900 cc) versus 968 cc (range: 1110 cc - 897 cc) in the suture arm p < 0.02). There was no post-operative hemorrhage or return to the operating room in either arm. Two patients, one in each arm, received two units of blood for a slowly decreasing hematocrit on postoperative day 3. There was no evidence of collateral tissue injure and no injuries to the urinary or intestinal tract in either arm.

Conclusions: Ligasure is a safe and effective alternative to sutures in cystectomy and bladder replacement, resulting in decreased blood loss and significant time saving.