Application of delayed ligature of the dorsal vasculature complex during laparoscopic radical prostatectomy

Abstract

Objective To describe a technique of delayed ligature of the dorsal vasculature complex (DLDVC) for laparoscopic radical prostatectomy(LRP) and to evaluate its postoperative outcomes. Methods From January 2007 to June 2015, 75 patients who underwent laparoscopic radical prostatectomy were retrospectively evaluated in the Jinhua Hospital of Zhejiang University. Their mean age was 63.7 (49-74) years, preoperative prostate specific antigen 13.0 μg /mL, Gleason score 6.8, preoperative prostate volume 56.8 mL, preoperative potency [international index of erectile 5(IIEF-5) score≥15 score]. TNM clinical stage: cT1 49 patients, 26 patients cT2. According to the hospital parity, they were randomly divided into DLDVC, SLDVC groups. No differences were found between the two groups in terms of preoperative prostate specific antigen values, Gleason score at biopsy, preoperative good potency (IIEF-5 score)and age(all P values>0.05). All patients were undergone LRP, including 33 patients (Group DLDVC) with DLDVC for laparoscopic radical prostatectomy, 42 patients (Group SLDVC) with the technique of standard ligature of the dorsal vasculature complex (SLDVC) for laparoscopic radical prostatectomy. The two groups were compared for perioperative variables, positive surgical margin rate, postoperative urinary continence functional and potency (IIEF-5 score). Results No differences were found between the two groups in terms of operative times[(240±87)min vs.(220±74)min], blood loss[(410±92)mL vs. (370±79)mL], postoperative stay[(9.2±1.1)d vs. (9.4±1.3)d], histologic status, positive surgical margin [(21.2%(7/33) in group DLDVC vs. 16.7%(7/42) in group SLDVC](all P values>0.05). Follow-up was 21(6-53) months. In DLDVC, the continence rate was 60.6%(20/33), 78.8%(26/33) , 87.9%(29/33) and 93.9%(31/33) at immediately after catheter removal, 1, 3 and 6 months, respectively. In the SLDVC it was 23.8%(10/42), 54.8%(23/42) , 71.4%(30/42) and 90.5%(38/42) at immediately after catheter removal, 1, 3 and 6 months, respectively. The group DLDVC showed a significantly earlier recovery from incontinence compared with that in the group SLDVC at immediately after catheter removal and 1 month, (all P values 0.05). Regarding sexual function, at the postoperative 3, 6, 12 months, median IIEF-score was 8.4±7.2、9.1±7.3、14.4±7.1 in the group DLDVC, respectively, and in the group SLDVC it was 7.3±6.1、7.4±6.7、11.1±9.3 respectively. Baseline IIEF-score was reached by 38.1%(5/30) and 16.7%(5/30) at postoperative 12 months. There were no significant differences between the two groups(χ2=2.992, P>0.05). Conclusions This delayed ligature of the DVC after its section can contribute to early recovery of continence. It has little to do with postoperative erectile function recovery and will not affect the positive surgical margin rate of oncology. Key words: Prostatectomy; Laparoscope; Dorsal vein complex; Erectile dysfunction; Urinary incontinence