Use of a Novel Absorbable Barbed Plastic Surgical Suture Enables a “Self-Cinching” Technique of Vesicourethral Anastomosis During Robot-Assisted Prostatectomy and Improves Anastomotic Times

Tewari, Ashutosh; Srivastava, Abhishek; Sooriakumaran, Prasanna; Slevin, Adam; Grover, Sonal; Waldman, Olivia; Rajan, Sivaram; Herman, Michael; Berryhill, Roy; Leung, Robert

doi:10.1089/end.2010.0316

Cited by 88 publications

(69 citation statements)

References 24 publications

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“…In other published series, time to completion of the anastomosis was faster using barbed versus nonbarbed suture (8 to 19 minutes faster) (21)(22)(23). In our series, the lack of difference may be due to resident involvement in operative cases, as our institution is a teaching hospital.…”

Section: Discussionmentioning

confidence: 51%

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Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

et al. 2012

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INTRODuCTIONRobotic-assisted laparoscopic prostatectomy (RALP) is a widely utilized, minimally invasive option for the treatment of prostate cancer and, in the short term, has demonstrated similar oncologic outcomes when compared with the open radical prostatectomy (1,2). The urethrovesical anastomosis (UVA) is a technically challenging aspect of RALP (3). Several UVA techniques have been described including a running suture anastomosis, interrupted suPurpose: V-Loc™180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl™ (Ethicon, Somerville, nJ). Materials and Methods: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between november 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. Results: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc™180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc™180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident. Conclusions: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc™180 was associated with improved early continence, this difference was transient.

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Section: Discussionmentioning

confidence: 51%

“…Only immediate perioperative data have been assessed in these studies and as such 2 and 5 month follow-up for continence or bladder neck contractures are not reported (21)(22)(23)(24). In the comparative studies, no data is provided for urinary incontinence between patients undergoing the UVA with barbed versus standard monofilament suture.…”

Section: Discussionmentioning

confidence: 99%

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

et al. 2012

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“…These surgical techniques include: two independent continuous sutures (7), or use of unidirectional (8,9) and bidirectional barbed sutures (10,11). Despite these advances in anastomotic technique, contemporary rates of urinary leak remain high and have been reported to be between 4.5% and 7.5% (4,(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model

Perera

Divakaran

Roberts

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Cite this article as: Marlon Perera, Pranav Divakaran, Matthew Roberts and Eric Chung, Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model, Journal of the Mechanical Behavior of Biomedical Materials, http://dx.doi.org/10.1016Materials, http://dx.doi.org/10. /j.jmbbm.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. MethodsMale porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied util failure of the catheter balloon or the model VUA. Model failure was defined as either 'VUA rupture', 'Catheter passage through VUA' or 'catheter failure'. ResultsTwenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with ovalballoon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). ConclusionsDuring prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.3

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“…İlk olarak plastik cerrahi operasyonlarında ve jinekolojik operasyonlarda kullanıl-maya başlanmıştır. Dikiş materyalinin kilitlemeye ihtiyaç duymadan gerginliğini koruyabilmesinin, sıcak iskemi sü-resini kısaltabileceğini akla getirmiş ve ürolojide ilk olarak 2010 yılında robot yardımlı radikal prostatektomi ve LPN'de kullanılmıştır [11,12,13] .Ürolojide KDDM kullanımının giderek yaygınlaşması, etkinlik ve güvenilirliğinin incelenmesi gereğini ortaya çıkarmış-tır. Bu çalışmada LPN operasyonlarında kendinden dikenli dikiş materyalinin (KDDM) kullanılmasının perioperatif parametreler ve postoperatif fonksiyonel sonuçlar üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır.…”

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The Impact of Self-Relating Barbed Suture Use for Laparoscopic Partial Nephrectomy on Perioperative Parameters and Postoperative Functional Outcomes

Aykan¹

2017

Haydarpasa Numune Med J

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Giriş ve Amaç:Böbrek tümörü nedeniyle yapılan nefron koruyucu cerrahi yöntemlerin, radikal nefrektomi olguları ile benzer onkolojik sonuçlara ve uzun dönemde daha iyi fonksiyonel sonuçlara sahip olduğu bilinmektedir. Deneyimli merkezlerde minimal invaziv cerrahi yöntemlerle yapılan nefron koruyucu operasyonlar (Laparoskopik Parsiyel Nefrektomi, LPN) radikal nefrektomiye karşı güvenli ve etkin bir alternatif olarak kabul görmüştür. Bu çalışma ile laparoskopik operasyonlarda kendinden dikenli dikiş materyalinin (KDDM) kullanılmasının perioperatif parametreler ve postoperatif fonksiyonel sonuçlar üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır. Yöntem ve Gereçler: Bağcılar Eğitim ve Araştırma Hastanesi, Üroloji Kliniği'nde Kasım 2008 ile Aralık 2016 tarihleri arasında, renal kitle nedeni ile tek cerrah tarafından LPN yapılan 83 hastanın verileri retrospektif olarak incelenmiştir. Hastalar operasyonlarda kullanılan dikiş materyalinin türüne göre iki gruba ayrılmıştır. Birinci grupta; renorafi ve/veya toplayıcı sistem onarımının 3/0 emilebilen polyglactin dikiş materyali ile yapıldığı 38 hasta, ikinci grupta; renorafi ve/ veya toplayıcı sistem onarımının KDDM (V-Loc) ile yapıldığı 45 hasta bulunmaktadır. İki grup arasında; demografik özel-likler, radyolojik bulgular, tahmini kan kaybı miktarı ve sıcak iskemi süresi (SİS) gibi perioperatif değerler, onkolojik sonuçlar, komplikasyonlar ve postoperatif fonksiyonel değerler karşılaştırılmıştır. Bulgular: Yaş, vücut kitle indeksi (VKİ), ASA (American Society of Anesthesiologists) skoru, tümör boyut ve tarafları, PADUA skoru, operasyon süresi, komplikasyon oranı ve hastanede kalış süresi gibi temel özelliklerin gruplar arasında benzer olduğu görülmüştür. İkinci grupta birinci gruba göre tahmini kan kaybı miktarı daha az olarak saptanmıştır (grup I:202.1 cc; grup II:179.77 cc, p=0.001). İkinci grupta SİS daha kısa olarak saptanmıştır (grup I:23.81 dk.; grup II:16.42 dk. p=0.001). Operasyon sonrası takiplerde böbrek fonksiyonları ikinci grupta daha iyi olarak saptanmıştır (p=0.003). Tartışma ve Sonuç: Böbrek tümörü tedavisinde uygulanan LPN'de kullanılan KDDM'nin sıcak iskemi süresi, tahmini kan kaybı ve postoperatif fonksiyonel sonuçlarda olumlu kazanımlar sağladığı görülmüştür. Laparoskopik parsiyel nefrektomi operasyonlarında KDDM'nin kullanılması etkin ve güvenilir bir seçenek olarak değerlendirilmiştir. Anahtar sözcükler: Böbrek tümörü; kendinden dikenli dikiş; laparoskopik parsiyel nefrektomi; sıcak iskemi süresi. 142Aykan ve ark., Kendinden Dikenli Dikiş Materyali Kullanımı / doi: 10.14744/hnhj.2017.01643 R enal kitleler üriner sistemin sık görülen tümörlerin-dendir. Güncel teknolojik gelişmeler, erken evre böb-rek tümörlerinin (pT1a) tanı sıklığını oldukça artırmıştır [1] . Böbrek tümörü nedeniyle yapılan nefron koruyucu cerrahi yöntemlerin, radikal nefrektomi olguları ile benzer onkolojik sonuçlara ve uzun dönemde daha iyi fonksiyonel sonuçlara sahip olduğu bilinmektedir [2,3] . Bu nedenle böbrek fonksiyonlarını korumak için uygulanan Laparoskopik Parsiyel Ne...

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Use of a Novel Absorbable Barbed Plastic Surgical Suture Enables a “Self-Cinching” Technique of Vesicourethral Anastomosis During Robot-Assisted Prostatectomy and Improves Anastomotic Times

Cited by 88 publications

References 24 publications

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model

The Impact of Self-Relating Barbed Suture Use for Laparoscopic Partial Nephrectomy on Perioperative Parameters and Postoperative Functional Outcomes

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