Does The Training Level Of The First Assistant Have An Impact On Blood Loss In Radical Prostatectomies?
June 27th, 2008 | by admin |ORLANDO, FL (UroToday.com) - Blood loss in radical prostatectomies has been an issue for a long time. New operative techniques led to an optimization regarding not only nerve sparing but also blood sparing attempts. These investigators prospectively studied the influence of the training level of the assisting doctor regarding blood loss in radical prostatectomies.
364 patients underwent radical prostatectomy (nerve-sparing operation 75.3%) between November 2007 and October 2007 at one institution treated by one single surgeon. Of 364 patients, 319 could be evaluated in terms of blood loss. Assistance was done by doctors in their first year of specialization up to specialized and experienced urologists. Pelvic lymphadenectomy was performed on one side by the assistant under the guidance of the surgeon. Blood loss was calculated by three parameters: Measurement of hemoglobin before the operation and 24 hours after the operation; measurement of suction volume; and weight of all used compresses.
Taken together the drop of hemoglobin score was 2.52g/dl average (range 0-7.6); suction volume was 334.48ml average (min. 10ml, max. 1500ml) and weight of compresses was 392.21g in average (min. 9g, max 1173g). Only one patient needed transfusion with two erythrocyte concentrate one day after the operation. There was no significant variation regarding blood lowss in regard to the training level of the first assistant.
They conclude that for an experienced surgeon using modern operation techniques the impact of the assistant regarding blood loss seems negligible. In their data radical prostatectomy could be safely performed independent of the training level of the assistant.
Presented by Alexander Karl, MD, Derya Tilki, MD, Peter Stanislaus, MD, Alexander Buchner, MD, Patrick Weidlich, MD, Stefan Tritschler, MD, Christian Gratzke, MD, Frank Strittmatter, MD, Dirk Zaak, MD, Christian G Stief, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
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