Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Jan;32(1):45.e11-5.
doi: 10.1016/j.urolonc.2013.06.006. Epub 2013 Sep 17.

Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling device

Ian M Thompson 3rd  1 , Stephen F Kappa  2 , Todd M Morgan  1 , Daniel A Barocas  1 , Carl J Bischoff  1 , Kirk A Keegan  1 , Kelly L Stratton  1 , Peter E Clark  1 , Matthew J Resnick  1 , Joseph A Smith Jr  1 , Michael S Cookson  1 , Sam S Chang  1
Affiliations
Randomized Controlled Trial

Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling device

Ian M Thompson 3rd et al. Urol Oncol. 2014 Jan.

Abstract

Objectives: 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 and materials: 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.

Keywords: Bladder cancer; Blood transfusion; Cystectomy; Surgical blood loss.

PubMed Disclaimer

References

    1. Hanash KA, Peracha AM, Al-Zharani HM, et al. Radical cystectomy: minimizing operative blood loss with a “stapling technique”. Urology. 2000;56:488–91. - PubMed
    1. Koch MO, Seckin B, Smith JA., Jr Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol. 1995;154:996–1001. - PubMed
    1. Rosario DJ, Becker M, Anderson JB. The changing pattern of mortality and morbidity from radical cystectomy. BJU Int. 2000;85:427–30. - PubMed
    1. Chang SS, Smith JA, Jr, Wells N, et al. Estimated blood loss and transfusion requirements of radical cystectomy. J Urol. 2001;166:2151–4. - PubMed
    1. Lowrance WT, Rumohr JA, Chang SS, et al. Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol. 2008;179:1313–8. - PubMed

Publication types