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Since its introduction, robot-assisted radical prostatectomy (RARP) have become the standard surgical approach for the treatment of prostate cancer in the United States and then in Europe. Continuous refinements of surgical technique has been described in order to maximise outcomes while minimizing morbidities.
The management of DVC is a crucial steps during RARP. It could be done prior or after its transection thanks to haemostatic effects of the pneumoperitoneum. This topic has been already investigated by some authors. However, no high quality evidence is available to opt in favour of either of the two approaches. Findings about estimated blood loss, positive surgical margins and urinary recovery differ among these studies and only one is a randomized controlled trial in a laparoscopic setting with a limited number of patients.
Therefore, our objective was to evaluate in a prospective randomised setting whether a delayed ligation of the dorsal vascular complex impacted on perioperative, functional and oncological outcomes as compared to preventive ligation during robot-assisted radical prostatectomy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Preventive ligation | Other | Preventive ligation of DVC is done after the opening of endopelvic fascia and before bladder neck dissection. DVC is ligated at the level of the apex with a 8-fashion single stich (1-0 Monocryl® CT-1 stich) trying to preserve puboprostatic ligaments and the muscle fibres of the rabdosphincter. DVC is then dissected at the end of prostatectomy before the section of the urethra. |
|
| Delayed ligation | Other | Delayed ligation is done after the section of the urethra and once the prostatectomy is completed with a single stich (3-0 Monocryl® UR-6). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DVC ligation | Procedure | Ligation of the dorsal vascular complex during robot-assisted radical prostatectomy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative estimated bool loss | intraoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Transfusion rate | 30 days from surgery | |
| Overall positive surgical marigins | intraoperative | |
| Apical positive surgicals margins |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Department of Urology, university Hospital Spedali Civili di Brescia | Brescia | 25123 | Italy |
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| ID | Term |
|---|---|
| D011471 | Prostatic Neoplasms |
| ID | Term |
|---|---|
| D005834 | Genital Neoplasms, Male |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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| intraoperative |
| 1-month continence | 0 or 1 security pad per day | 30 days from surgery |
| 1-month PSA | 30 days from surgery |
| D005832 |
| Genital Diseases, Male |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D011469 | Prostatic Diseases |
| D052801 | Male Urogenital Diseases |