Tzortzis Vassilios, Gravas Stavros, Mitsogiannis Iraklis C, Moutzouris Georgios, Karatzas Anastasios, Leventis Angelos, Mpouzalas Ioannis, Melekos Michael D
Department of Urology, University of Thessaly School of Medicine, Larissa, Greece.
Urology. 2008 Feb;71(2):337-40. doi: 10.1016/j.urology.2007.10.032.
To compare effectiveness in terms of blood loss and operative time of stapling devices among surgeons with different levels of surgical volume.
We evaluated a group of 29 male patients with invasive bladder cancer who underwent radical cystectomy by two groups of surgeons. The first group included two high-volume surgeons, and the second group two low-volume surgeons. All cystectomies were performed using the multifire autosuture articulated vascular Endo-GIA. We compared patients with a series of 28 patients who had undergone radical cystectomy during the same period using standard technique by the same surgeons. Blood loss was defined as the difference between the hemoglobin at the beginning and at the end of cystectomy.
In the group of high-volume surgeons, the mean operative time was 81.4 +/- 17 minutes and 79.3 +/- 20 minutes for the classical and stapler arm, respectively (P = 0.551). In the low-volume surgeons group, the mean operative time was 114.3 +/- 22 minutes and 92.4 +/- 12 minutes for the two methods (P = 0.003). The mean intraoperative blood loss in the experienced surgeons was 2.3 +/- 0.82 g/dL and 1.49 +/- 0.66 g/dL for the classical and stapler arm, respectively (P = 0.008). In the group of low-volume surgeons, the difference in hemoglobin was 3.02 +/- 0.84 g/dL and 1.91 +/- 0.6 g/dL for the two methods (P = 0.02).
Stapling devices seem to make cystectomy safer and faster in surgeons with different surgical volumes. The group of low-volume surgeons benefited more.
比较不同手术量的外科医生使用吻合器在失血和手术时间方面的效果。
我们评估了一组29例浸润性膀胱癌男性患者，他们由两组外科医生进行根治性膀胱切除术。第一组包括两名高手术量的外科医生，第二组包括两名低手术量的外科医生。所有膀胱切除术均使用多钉仓自动缝合关节式血管腔内吻合器（Endo-GIA）进行。我们将这些患者与同期由相同外科医生使用标准技术进行根治性膀胱切除术的28例患者进行了比较。失血定义为膀胱切除术开始和结束时血红蛋白的差值。
在高手术量外科医生组中，经典手术臂和吻合器臂的平均手术时间分别为81.4±17分钟和79.3±20分钟（P = 0.551）。在低手术量外科医生组中，两种方法的平均手术时间分别为114.3±22分钟和92.4±12分钟（P = 0.003）。经验丰富的外科医生中，经典手术臂和吻合器臂的平均术中失血量分别为2.3±0.82 g/dL和1.49±0.6 g/dL（P = 0.008）。在低手术量外科医生组中，两种方法的血红蛋白差值分别为3.02±0.84 g/dL和1.91±0.6 g/dL（P = 0.02）。
吻合器似乎能使不同手术量的外科医生进行膀胱切除术时更安全、更快。低手术量外科医生组受益更多。
