Modified technique for laparoscopic running vesicourethral anastomosis.

Abstract

IntroductionA vesicourethral anastomosis is the most challenging and time-consuming step of radical prostatectomy. In 2003, van Velthoven introduced his own technique of connecting the bladder neck with the membranous urethra, which has remained the most popular method since. Despite being effective, this method is time consuming and is not free from the risk of complications.AimHere we describe our technique for laparoscopic vesicourethral anastomosis using a running suture as an alternative to the traditional approach.Material and methodsThe vesicourethral anastomosis is created using a running stitch placed first at the 5 o'clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out. Proceeding anticlockwise, the running suture is placed 5 times more through both the bladder neck and the urethra in a similar fashion until it meets the free end at the 5 o'clock position. A single knot is then tied outside the bladder.ResultsThe anastomotic technique has been used in 28 patients with clinically organ confined prostate cancer. The mean anastomosis time was 9.53 min, the mean operative time was 155.20 min, the mean drain permanence was 2.71 days, and the mean catheterisation time was 17.28 days. Continence rate 3 months after surgery was 92.85%, and 100% at 6- and 12-month follow-up visits.ConclusionsWe describe a safe, feasible and efficient technique for vesicourethral anastomosis. Further studies on a larger group of patients are needed to confirm our encouraging preliminary results.

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

“…The Van Velthoven anastomosis is relatively complex and has an average reported completion time ranging from 18.2 to 35 min [7,11,20]. In comparison, the published completion time of the single running suture anastomosis in different modifications ranges from 9.5 to 18 min [9,12,18,21]. Although our results are statistically significant with regard to the average reduction of anastomosis time and the mean operative time for the single running suture technique, one may question their consequences to the patient and whether reducing the total procedure time by 10 min has any relevant impact on outcomes.…”

“…Postoperative VUA leakage is one of the most bothersome complications of radical prostatectomy, as it may result in poor anastomosis healing, urethral stricture, urinoma as well as abscess formation [3,5,6]. In an attempt to simplify this critical step of LRP, several authors have proposed different techniques for the VUA [7,8,9,10,11,16]. The single-knot running Van Velthoven method, which was introduced to the urological community in 2003, has been adopted by many laparoscopic surgeons, as it ensures the adequate formation of the VUA and consequently a good functional outcome [7,11,12].…”

“…Immediately after urethral transection and haemostasis were completed, the VUA was fashioned with a running suture using our own modification, as described in detail elsewhere [9]. This consists of a running stitch (2-0 polyglactin, absorbable synthetic suture) being placed first at the 5 o'clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out.…”

“…In addition, anastomotic urinary leakage and bladder neck strictures may result in urinary retention, pelvic abscess and a delayed return of continence, complications which commonly necessitate secondary procedures [3,5,6]. In the quest for an optimal VUA, several modifications have been previously described including interrupted and running sutures [7,8,9,10,11]. A running suture is faster and easier to perform, with fewer knots required than the interrupted one [10].…”

“…Despite being effective, this method is time consuming and is not free of complications [10,11,12]. In 2009, we developed an alternative technique for laparoscopic running VUA, the Chlosta's running VUA method [9]. …”