Division of dorsal vascular complex using soft coagulation without suture ligation during robot-assisted laparoscopic radical prostatectomy: A propensity score-matched study in a single-center experience

Objectives: Apical
dissection and control of the dorsal vascular complex affects blood loss,
positive surgical margins, and urinary control during robot-assisted
laparoscopic radical prostatectomy. Soft coagulation is widely used for
hemostasis. However, using soft coagulation to the dorsal vascular complex may
affect the continence outcomes. In this study, we described technique and outcomes
for division of the dorsal vascular complex after soft coagulation compared
with delayed ligation of the dorsal vascular complex.

Method: Medical
records of 170 patients who underwent robot-assisted laparoscopic radical
prostatectomy from June 2016 to March 2020 were retrospectively reviewed. To
reduce the selection bias, the two groups were matched in a 1:1 ratio on the
basis of propensity scores. Perioperative data and results were compared in
both groups.

Results: Patients
undergoing division of the dorsal vascular complex after soft coagulation group
versus delayed ligation of the dorsal vascular complex group experienced less
estimated blood loss (median: 105.5 vs. 225 ml, p=0.017). Postoperative
continence rates at 1 week, 1, 3, 6 months in division of the dorsal vascular
complex after soft coagulation group and delayed ligation of the dorsal
vascular complex group were 32.5% versus 15%, 62.5% versus 32.5%, 85% versus
67.5%, 95% versus 90%, respectively.

Conclusions:
division of the dorsal vascular complex after soft coagulation technique did
not affect continence after robot-assisted laparoscopic radical prostatectomy
despite the thermal division and gave the surgeon good hemostasis with simple
procedure.