Radical retropubic prostatectomy using endoscopic gastrointestinal anastomosis staplers. Commentary

Objective: To investigate whether the use of the endoscopic gastrointestinal anastomosis (GIA) stapler for hemostasis of the dorsal vein complex during radical retropubic prostatectomy saves operation time and blood loss together with therapeutic efficacy. Materials and Methods: From April 1990 to December 1998, a total of 296 patients underwent radical retropubic prostatectomy for prostate cancer in clinical stages T1, T2 and T3. In 157 patients we evaluated the efficacy of the endoscopic GIA stapler in order to minimize blood loss from the dorsal vein complex and to reduce mean operative time. Results: The mean total operative time decreased an average of 35 min and the mean blood loss fell from 850 to 400 cm 3 using the stapling technique. Although complications are seen with traditional methods, we noted a net increase in anastomotic strictures with this new technique. Conclusions: Even if this technical trick is effective in reducing blood loss, a higher incidence of anastomotic strictures has to be taken into account when using staplers close to the anastomotic site.