Decreasing Blood Loss in Patients Treated With Radical Cystectomy: A Prospective Randomizes Trial Using A New Stapling Device

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Abstract
Radical cystectomy has been associated with significant blood loss and the need for heterologous transfusion. We investigated the potential decrease in blood loss and/or in transfusion requirement using a new stapling device compared with the traditional suture ligation technique. We prospectively examined 70 patients with urothelial carcinoma who were scheduled for radical cystectomy. Each patient was randomized to traditional suture ligation or the Compact Flex Articulating Linear Cutter (Ethicon Endo-Surgery, Cincinnati, Ohio) stapling device. The 2 groups were prospectively compared with respect to estimated blood loss, transfusion requirement, operative time and complications. The groups were equivalent in terms of demographic and clinical variables, indicating that randomization produced 2 comparable groups. The stapler group had significantly lower estimated blood loss during cystectomy (p = 0.007) and during the whole procedure (p = 0.02). This group also required fewer transfusions (p = 0.006) and fewer mean units transfused (p = 0.003). The overall transfusion rate was 20% (14 of 70 cases). All patients in the stapler group had lower estimated blood loss and transfusion requirements. There was no statistical difference in time needed for bladder removal (p = 0.91) or total operative time (p = 0.17). No complications were attributable to the stapler device. In this prospective randomized study the stapling device significantly decreased blood loss and the transfusion requirement during radical cystectomy. These significant advantages combined with its relative safety make it an attractive surgical option and argue in favor of continued strategic attempts to decrease blood loss during radical cystectomy.