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The impact of staple transection of the dorsal venous complex and urethra on intraoperative blood loss in cooperative laparoscopic and transperineal endoscopic pelvic exenteration

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Abstract

Purpose

While laparoscopic pelvic exenteration reduces intraoperative blood loss, dorsal venous complex bleeding during this procedure causes issues. We previously introduced a method to transect the dorsal venous complex and urethra using a linear stapler during cooperative laparoscopic and transperineal endoscopic (two-team) pelvic exenteration. The present study assessed its effectiveness in reducing intraoperative blood loss by comparing it with conventional laparoscopic pelvic exenteration.

Methods

This retrospective cohort study was conducted at a Japanese tertiary referral center. Eleven cases of two-team laparoscopic pelvic exenteration with staple transection of the dorsal venous complex (T-PE group) were compared to 25 cases of conventional laparoscopic pelvic exenteration (C-PE group). The primary outcome measure was intraoperative blood loss.

Results

There were no significant between-group differences in patient background. The mean intraoperative blood loss was significantly lower in the T-PE group than in the C-PE group (200 vs. 850 mL, p = 0.01). The respective mean operation time, postoperative complication rate, and R0 resection rate were similar between the T-PE and C-PE groups (636 min vs. 688 min, p = 0.36; 36% vs. 44%, p = 0.65; 100% vs. 100%, p = 1.00).

Conclusions

Two-team laparoscopic pelvic exenteration with staple transection of the dorsal venous complex reduced intraoperative blood loss from the dorsal venous complex in a technically safe and oncologically feasible manner.

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Availability of data and materials

The data sets generated and/or analyzed during the current study are not publicly available due to privacy and ethical concerns.

Code availability

Not applicable.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan

    Toshiki Mukai, Toshiya Nagasaki, Takashi Akiyoshi, Yukiharu Hiyoshi, Tomohiro Yamaguchi & Yosuke Fukunaga

  2. Department of Pathology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan

    Hiroshi Kawachi

Authors
  1. Toshiki Mukai
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  2. Toshiya Nagasaki
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  3. Takashi Akiyoshi
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  4. Yukiharu Hiyoshi
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  5. Tomohiro Yamaguchi
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  6. Hiroshi Kawachi
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  7. Yosuke Fukunaga
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by TM, YF, and TN. All resected specimen was pathologically evaluated by HK. The first draft of the manuscript was written by TM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshiki Mukai.

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Informed consent was obtained from all participants included in the study.

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Patients gave their signed informed consent regarding the publication of their data and photographs.

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Mukai, T., Nagasaki, T., Akiyoshi, T. et al. The impact of staple transection of the dorsal venous complex and urethra on intraoperative blood loss in cooperative laparoscopic and transperineal endoscopic pelvic exenteration. Surg Today 54, 23–30 (2024). https://doi.org/10.1007/s00595-023-02693-x

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  • DOI: https://doi.org/10.1007/s00595-023-02693-x

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