Effect of Oversewing vs Stapling the Dorsal Venous Complex on Positive Margins in Robotic Prostatectomy

Introduction: During robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer treatment, several methods are used to control the dorsal venous complex (DVC), including oversewing or using the robotic stapler. This study compared overall and apical positive surgical margin (PSM) rates between these 2 techniques; secondary outcomes included 30-day complications, hematocrit change, hospital length of stay, and surgical costs. Methods: A single-center retrospective review of patients undergoing RALP between 2017 and 2024 was performed. Patients were categorized into the oversewing or stapling group. PSM rates were compared using log-binomial regression models. Surgical costs were estimated from facility equipment charges and an estimated operating room (OR) time cost of $36 per minute. Results: A total of 267 patients were included in the study, with 43 (16.1%) in the oversewing group and 224 (83.9%) in the stapling group. Overall, PSM rates were similar in the oversewing and stapling groups (30.8% vs 30.2%, P = .941), as were apical PSM rates (8.9% vs 9.3%, P = .931). No significant differences were found in 30-day complications, length of stay, or hematocrit changes. The oversewing method was $547 less expensive than the stapling method, factoring in equipment and OR time costs. Conclusions: The oversewing and stapling methods perform similarly with respect to overall and apical PSM status. Patient outcomes, including 30-day complication rates, length of stay, and hematocrit changes, are equally favorable with both methods. Despite these similar patient outcomes, the oversewing method warrants consideration among urologists because it is a more cost-effective approach for controlling the DVC.