Blood loss associated with radical cystectomy: A prospective, randomized study comparing Impact LigaSure vs. stapling device
Thompson IM 3rd1, Kappa SF2, Morgan TM1, Barocas DA1, Bischoff CJ1, Keegan KA1, Stratton KL1, Clark PE1, Resnick MJ1, Smith JA Jr1, Cookson MS1, Chang SS1. Urol Oncol. 2014 Jan;32(1):45.e11-5. doi: 10.1016/j.urolonc.2013.06.006. Epub 2013 Sep 17.

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1Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. 2Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address:


OBJECTIVES: Radical cystectomy (RC) is associated with significant blood loss and transfusion requirement. We performed a prospective, randomized trial to compare blood loss, operative time, and cost using 2 different and commonly employed approaches to tissue ligation and division during RC: mechanical (stapler device) and electrosurgical (heat-sealing device).

METHODS AND MATERIALS: Eighty patients undergoing RC for urothelial bladder carcinoma were randomized to use of either an Endo GIA Stapler or Impact LigaSure device for tissue ligation and division. Primary outcomes were blood loss, operative time, and device costs. Data were analyzed with Wilcoxon rank sum test and Welch 2-sample t test.

RESULTS: There were no significant demographic or preoperative differences between the cohorts. Mean estimated blood loss was similar between the electrosurgical (687ml) and stapler (708ml) arms (P = 0.850). There were no significant differences between cohorts when comparing operative times or transfusion requirement. There was a significant increase in the mean number of adjunctive suture ligatures used in the stapling device arm (3.0 vs. 1.5, P = 0.047). Total device costs were significantly lower with the LigaSure compared with the GIA Stapler ($625.00 vs. $1490.10, P<0.001). There were no complications attributable to either device.

CONCLUSIONS: This prospective, randomized study demonstrates no significant difference in blood loss, transfusion requirement, or safety between mechanical vs. electrosurgical control of the vascular pedicles. The LigaSure device, however, is significantly less costly than the GIA Stapler and required fewer additional measures for hemostasis.