Hermans Thomas, Schevenels Giel, Motmans Steve, De Sutter Thomas, Raskin Yannic
Department of Urology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk, 3600, Belgium.
Department of Molecular Biology, ULB Neuroscience Institute, Université libre de Bruxelles (ULB), 12 rue des Profs. Jeener et Brachet, Gosselies, 6041, Belgium.
BMC Urol. 2025 Apr 11;25(1):85. doi: 10.1186/s12894-025-01763-1.
Radical cystectomy is the primary treatment for muscle-invasive bladder cancer and certain cases of high-risk non-muscle-invasive disease. Robot-assisted cystectomy techniques (RARC) have emerged as a minimally invasive alternative to traditional open surgery, offering enhanced precision and potentially improved recovery. Bowel anastomosis remains a critical step in these procedures, with manually sutured anastomosis offering a cost-effective alternative to the standard stapled technique. However, concerns remain regarding its impact on surgical outcomes.
We conducted a retrospective study of 92 patients who underwent RARC in our hospital between March 2021 and November 2023. Bowel anastomosis was performed using either stapled (n = 33) or manually sutured techniques (n = 59). Key outcome parameters included gastro-intestinal (GI) complications, overall complications, operation duration, length of hospital stay, readmissions, and postoperative recovery metrics.
GI complications occurred in 23 patients (25%), with paralytic ileus being the most common (17%). The rates of GI complications were comparable between the manually sutured (27%) and stapled (21%) groups (p = 0.530, odds ratio 1.38). The mean operation duration was 300 min for the sutured group and 313 min for the stapled group (p = 0.124). The median hospital stay was similar at 8 days (p = 0.384) for both groups. Readmission rates were higher in the sutured group (25% vs. 6%, p = 0.022, odds ratio 5.28), but this was predominantly due to non-GI complications.
This study indicates that outcomes are comparable between stapled and manually sutured bowel anastomosis in RARC, with no significant increase in overall complications, GI complications, operation duration or hospital stay if using a manually sutured anastomosis. Considering the low cost of manual suturing, this technique seems highly cost-effective and could be considered a viable alternative to existing stapling techniques.
根治性膀胱切除术是肌层浸润性膀胱癌及某些高危非肌层浸润性疾病病例的主要治疗方法。机器人辅助膀胱切除术技术（RARC）已成为传统开放手术的微创替代方法，具有更高的精准度，并可能改善恢复情况。肠道吻合术仍是这些手术中的关键步骤，手工缝合吻合术为标准吻合器技术提供了一种经济有效的替代方案。然而，其对手术结果的影响仍存在担忧。
我们对2021年3月至2023年11月期间在我院接受RARC的92例患者进行了回顾性研究。肠道吻合术采用吻合器（n = 33）或手工缝合技术（n = 59）进行。关键结局参数包括胃肠道（GI）并发症、总体并发症、手术时间、住院时间、再次入院情况以及术后恢复指标。
23例患者（25%）发生了胃肠道并发症，其中麻痹性肠梗阻最为常见（17%）。手工缝合组（27%）和吻合器组（21%）的胃肠道并发症发生率相当（p = 0.530，比值比1.38）。缝合组的平均手术时间为300分钟，吻合器组为313分钟（p = 0.124）。两组的中位住院时间相似，均为8天（p = 0.384）。缝合组的再次入院率较高（25%对6%，p = 0.022，比值比5.28），但这主要是由于非胃肠道并发症。
本研究表明，在RARC中，吻合器和手工缝合肠道吻合术的结果相当，如果使用手工缝合吻合术，总体并发症、胃肠道并发症、手术时间或住院时间均无显著增加。考虑到手工缝合成本较低，该技术似乎具有很高的成本效益，可被视为现有吻合器技术的可行替代方案。
