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The authors present a pragmatic evaluation of dorsal venous complex (DVC) control during radical prostatectomy, comparing robotic stapling with suture ligation. 1 While technical in nature, this question reflects a broader issue in contemporary urologic surgery: How operative choices influence oncologic outcomes, efficiency, and cost. Their finding that DVC suture ligation did not affect positive surgical margin rates is reassuring (30. 8 vs 30. 2%), particularly given the perceived advantage of staplers in improving visualization through reduced bleeding. In this cohort, those theoretical benefits did not translate into measurable oncologic differences. Previous data have also suggested that suture ligation can provide opportunity to improve outcomes such as continence through suspension to the pubic bone. 2 The implications for cost and efficiency are equally important. Although stapling reduced DVC control time (4 vs 7 minutes), it incurred an additional cost of approximately 550 per case. In an era of increasing emphasis on value-based care, this difference is meaningful—particularly when extrapolated across institutions. These findings suggest that suture ligation may offer a cost-conscious alternative without compromising outcomes. Several limitations warrant consideration. The comparison is confounded by surgeon-specific factors because 1 surgeon performed all suture ligation while the other 4 used stapling. Differences in experience and technique may influence outcomes, independent of DVC control method. In addition, the study may be underpowered to detect small but clinically meaningful differences in margin rates. Despite these limitations, the authors provide a meaningful contribution. Their findings challenge assumptions regarding stapler superiority and highlight the importance of critically evaluating both outcomes and cost in surgical innovation.
Filon et al. (Fri,) studied this question.