Stapled versus robot-sewn ileo-ileal anastomosis during robot-assisted radical cystectomy: a review of outcomes in urinary bladder cancer patients

Aljabery, Firas; Jancke, Georg; Skoglund, Per H.; Hallböök, Olof

doi:10.1080/21681805.2020.1843534

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…All these factors have been investigated in the Cochrane review by Choy et al [8]. Anastomotic leak remains a significant cause of morbidity and mortality after intestinal resections [9]. An ideal anastomosis requires an adequate blood supply, tension-free serosal apposition, and an uncompromised lumen with a watertight seal [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…The cost for the stapling device is 350 € when using Ethicon Endo Surgery™ Linear Cutter Johnson & Johnson. Depending on the number of stapling cartridges, the total cost for a stapled anastomosis reaches 350 € for the ileo-ileal anastomosis using two 55 mm cartridges [9]. In contrast, the cost for the two 4-0 Vicryl and two 3-0 Vicryl sutures is negligible (Table 5).…”

Section: Discussionmentioning

confidence: 99%

“…Both sutured and stapled anastomoses involve the introduction of foreign materials that penetrate and injure the bowel wall thus potentiating a localized inflammatory response [12]. Hand-sewn anastomoses are technically challenging, while stapled anastomoses are more expensive and are associated with a higher rate of technical mishap in the operating room [9, 13].…”

Section: Discussionmentioning

confidence: 99%

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Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Tulone,

Pavan,

Giannone

et al. 2023

Urol Int

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Introduction: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. Results: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9–12 with HS-IA vs. 13 days range 12–16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. Conclusion: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Tulone,

Pavan,

Giannone

et al. 2023

Urol Int

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“…The safe use of a stapler for ileo-ileal anastomosis has been yet debated in the literature, and it is routinely performed. Indeed, the stapler anastomosis ensures waterproofing sutures allowing to reduce the risk of leakage and dehiscence; with respect to the handsewn technique, the stapler anastomosis has either the same or a lower percentage of leakage ( 16 , 17 ). Whereas the fecal material in the small bowel is almost liquid, we feel that stapled urinary diversion reconstructions are at least as safe as those performed by hand.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications

et al. 2023

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IntroductionRadical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non–muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler.Material and methodsFrom January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien–Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications.ResultsOverall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones.ConclusionRARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.

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“…14 The advantages of the stapled method could be converted into benefits of functional recovery or reduced problems by using: consistent suture space; tight closure of suture nails, type "B" cross-stitch using titanium nails; inosculation and cutting stability may reduce the risk of infection due to manual operation and minimize the risk of pulling and clamping the jejunum, thus lowering GI bleed. 17,18…”

Section: Discussionmentioning

confidence: 99%

The Comparison of Hand Sewn and Stapled Anastomoses

Hussain

Jabbar

Ahmed

et al. 2022

PAFMJ

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Objective: To compare hand-sewn and stapled sutures and the influence of intestinal excision on postoperative complications. Study Design: Retrospective comparative study. Place and Duration of Study: General Surgery Department of CMH Peshawar, from Jan 2020 to Jan 2021. Methodology: Once receiving consent, all individuals hospitalized in the medical facility for ileostomy closure were included in our investigation. In a questionnaire, postoperative complications were documented. Result: This study involved a total of 60 subjects. Individuals were scheduled for surgery after receiving clearances and a loopogram distally. Thirty patients had their wounds hand-sewn shut, while 30 others had their wounds stapled shut. The mean operating time for the hand-sewn method was 2.46 ± 0.29 hours, compared to 1.86 ± 0.17 hours mean for the stapled method. In both categories, the anastomotic leak was comparable. Thirty patients in the hand-sewn group took a mean of 2.42 ± 0.25 days to return bowel sounds after surgery, whereas it took 1.83 ± 0.20 days to return bowel sounds. Conclusion: The stapler method greatly decreases the duration of surgery, promotes rapid recovery, and has a lower fatality rate. Stapling is a simple procedure that can be performed in inaccessible locations, such as a low colorectal anastomosis. In elective gastrointestinal procedures, stapler anastomosis can be utilized safely and successfully.

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Stapled versus robot-sewn ileo-ileal anastomosis during robot-assisted radical cystectomy: a review of outcomes in urinary bladder cancer patients

Cited by 5 publications

References 18 publications

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications

The Comparison of Hand Sewn and Stapled Anastomoses

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