Effective Control of the Dorsal Vein Complex during Radical Retropubic Prostatectomy Using a Two Suture Technique

Abstract

Introduction: Obtaining and maintaining control of the dorsal vein complex (DVC) remains a challenging problem for urologists during open radical retropubic prostatectomy. This article describes a two suture ligature technique which was effective in providing excellent control of the DVC in 39 of 42 (92.6 %) radical retropubic prostatectomies. Materials and Methods: A single surgeon performed 42 consecutive radical retropubic prostatectomies at a referral medical center. A McDougal right angle clamp was used to secure a #1 Vicryl suture in a distal position between the urethra and DVC. A second #1 Vicryl suture was used to form a doubly looped suture that slides to a maximally distal location past the first suture. Results: In 39 of 42 cases, the two suture technique was effective in obtaining and maintaining control of the distal DVC. In 2 cases, an additional figure-of-eight suture ligature of 2-0 Vicryl was used to secure the complex. Mean operative time was 150 minutes (range 120–210 minutes). Mean estimated blood loss was 926 ml (range 300–2,500 ml). Five patients (11.9 %) required postoperative blood transfusion. Conclusion: The technique described is an easy and effective way of obtaining maximal distal (caudad) ligation of the deep DVC during retropubic prostatectomy. Since developing this method, all of the surgeon’s partners have adopted the technique.