Page 100 - Read Online

Tak et al. Mini-invasive Surg 2018;2:15 I http://dx.doi.org/10.20517/2574-1225.2018.05 Page 3 of 8

Table 1. Gender distribution of study population
Male Female Total
Group A 46 7 53
Group B 57 6 63

various variables between these groups to assess the impact on outcomes. No patient was given neoadjuvant
chemotherapy.

Parameters analyzed were age (in years), gender, co-morbidity, history of smoking or tobacco chewing,
occupation, presentation, computed tomography findings, hydronephrosis, trans urethra resection of
bladder tumor report, duration of surgery (in minutes), hemoglobin drop (in gram per deciliter), need for
blood transfusion (number of units), hospital stay (in days), epidural analgesia, analgesic requirement (I.V.
Tramadol was the only analgesic used, in milligrams of tramadol, no narcotic used in any patient), pain score
on first three post operative days (on visual analogue scale), complications, wound complications specifically
mentioned needing conservative management or secondary re-suturing (dehiscence and burst abdomen),
delayed follow up, and lymph node yield (numbers). Standard steps were cystectomy with bilateral pelvic
lymphadenectomy done either through the laparoscopic or robotic approach and specimen retrieval along
with diversion through either Pfannenstiel or midline incision.

A midline incision begins with the vertical midline skin incision extending from pubic symphysis to just
above the umbilicus; next, the sheath was opened vertically and then peritoneum was reached. A pfannenstiel
incision begins with the transverse skin incision along the skin crease or 2-3 fingers above pubic symphysis
extending to lateral borders of rectus muscle on either site, and then the rectus sheath was opened vertically
to reach the peritoneum.

Primary endpoints in this study were postoperative pain score, analgesic requirement, postoperative wound
complications, length of hospital stay and secondary endpoints were duration of surgery, postoperative paralytic
ileus duration, postoperative hemoglobin drop, the number of units blood transfused, and lymph node yield.

We used a student's t-test for equality of means to compare various variables between the two groups. The
analysis done was multivariate analysis.

RESULTS
The gender distribution of two groups has been shown in Table 1.

We have compared group A and group B with especial focus on various variables [Table 2]. We found that
there was statistically significant (P < 0.0006) difference with regards to mean operative time which was 259
min for group A and 416 min for group B. This significant difference might be due to use of the midline
vertical incision during initial learning curve period. The mean postoperative hemoglobin drop for group A
was 1.75 g per deciliter; for group B it was 1.9 g per deciliter, which was statistically insignificant (P = 0.08).
There was higher mean lymph node yield in group A 22.27 compared to group B which had 20.74, but it
was not statistically significant (P = 0.533). The mean number of blood transfusions unit needed for group A
(0.74) was lower than that for group B (1.00), but it was not statistically significant (P = 0.189).

We found that there was a statistically significant (P = 0.000) difference with regards to mean postoperative
pain score on day 2 and day 3 between the studied groups, but the mean postoperative pain score for day 1 was
insignificant for these groups. Overall there was a significantly lower pain score in group A than group B. Accordingly
analgesic requirement (patients were administered injection tramadol intravenously, no additional regional/
epidural/systemic analgesia was given to any patient) was statistically significantly lower in group A as