Minimal Blood Loss in Patients Undergoing Radical Retropubic Prostatectomy

Abstract

The objective of this study was to evaluate blood loss in patients undergoing radical retropubic prostatectomy. Blood loss and operating time were evaluated in a series of 197 consecutive patients with prostate cancer who underwent radical retropubic prostatectomy by a two-surgeon team. The patients were positioned supine with the table flexed and the patient in about 35 degrees Trendelenburg position. Results were compared with those recorded for an earlier series of 40 patients operated in the supine position alone. The influence of parameters that might affect blood loss (peridural and hypotensive anesthesia, bilateral hypogastric artery clamping) was assessed in multivariate analyses. Since adoption of a Trendelenburg position with flexion of the hips, the mean intraoperative blood loss has decreased by 80%, to a low level of 260 cc; and transfusions have become exceptional (0.5%). The decrease in blood loss correlated with a decrease in operating time, which was reduced to an average of 90 minutes. Whereas epidural anesthesia decreased blood loss by a modest 27%, intraoperative blood pressure, bilateral hypogastric artery clamping, and nerve sparing had little or no significant effect. Patient position and the surgical skill of a two-man team can virtually eliminate the risk of blood loss during radical retropubic prostatectomy. There is thus no need always to resort to other procedures or to preoperative autologous blood donation.

Intraoperative red blood cell salvage and autologous transfusion during open radical retropubic prostatectomy: a cost–benefit analysis

“…2,3,12 Nevertheless, in many centres blood loss is still significant and often requires intervention in the form of HBT. This has lead to the search for more effective alternatives to HBT.…”

“…This has been reported even from high volume centres of excellence. [1][2][3][4] We have looked at the clinical and financial benefits of using intraoperative cell salvage (ICS) as a method of reducing the autologous blood transfusion requirements for our RRP patients. MATERIALS AND METHODS Group A comprised 25 consecutive patients who underwent RRP immediately prior to the acquisition of a cell saver machine.…”

“…Average blood loss of over 1,000ml has been reported even from high volume centres of excellence. [1][2][3][4] As a consequence, donated homologous blood transfusion (HBT) is frequently required. This is associated with significant risks, including allergic reactions and the transmission of blood borne infections.…”

Impact of Thoracic Epidural Analgesia on Blood Loss in Radical Retropubic Prostatectomy

“…Additionally, the average infusion volume was >4,000 ml/patient and the average transfusion quantities were 950 and 960 ml/patient and operation. Barré et al [20] examined 197 patients, mainly emphasising the patient's position and the surgeon's skills as favourable parameters with regard to blood loss in RRP. However, three study groups attributed a lower blood loss in RRP to perioperative EA: Dunet et al [21] (retrospective, n = 62 patients), O'Connor et al [22] (prospective, randomised, n = 102) and Tikuisis et al [23] (prospective, n = 54).…”

Neues Konzept minimiert die Blutung bei der radikalen retropubischen Prostatektomie

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