Vesicourethral anastomosis during endoscopic extraperitoneal radical prostatectomy: A prospective comparison between the single-knot running and interrupted technique

Poulakis, Vassilis; Skriapas, Konstantinos; Vries, Rachelle de; Dillenburg, Wolfgang; Witzsch, U.; Becht, E.

doi:10.1016/j.urology.2006.08.1063

Cited by 28 publications

(34 citation statements)

References 30 publications

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“…Studies have shown that a majority (79 to 95%) of patients undergoing radical prostatectomy do not have a urine leak by cystogram seven days postoperatively (13)(14)(15). By 15 to 21 days after surgery, nearly 100% of patients do not have a urinary leak at the UVA (13,16). The type or number of sutures used has not seemed to affect urinary leak rates, suggesting that the most important factor in a leak-free UVA is good tissue approximation and an intraoperative watertight closure.…”

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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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: 99%

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

et al. 2012

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“…A prospective comparison study showed that there were no differences in extravasation rate, catheterization time and occurrence of anastomotic strictures between the two types of techniques, but the running technique took less operative time and had a lower difficulty score [5]. Therefore, in this study, we developed an economical porcine model for LESS UVA training by using the running suture.…”

Section: Introductionmentioning

confidence: 99%

Laparoendoscopic Single-Site Urethrovesical Anastomosis Training in an Economical Porcine Model

et al. 2013

Urol Int

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Purpose: To develop an economical animal model for laparoendoscopic single-site surgery (LESS) urethrovesical anastomosis (UVA) training. Materials and Methods: A homemade single-port device was used and the uterus cervix and the ileum were chosen to simulate UVA to reduce costs. Ten trainees were randomly divided into two groups: the conventional LESS UVA (CLUVA) group and the transurethral assistant LESS UVA (TALUVA) group. In TALUVA, a laparoscopic forceps was inserted through the urethra to assist operation after the bladder neck was disconnected, whereas CLUVA followed the conventional steps. Anastomosis time and knotting time were recorded, and the learning curves of both groups were analyzed. After training, questionnaires were given to the trainees to assess the difficulties and the satisfaction of the training. Results: The final mean operating time significantly declined in both groups. Except for the first lesson, the trainees in the TALUVA group operated faster than those in the other group. The results from the questionnaires show that all trainees were satisfied with the training, and LESS UVA was considered more difficult in the CLUVA group than in the TALUVA group. Conclusions: The female porcine model for LESS UVA was feasible and cost-effective. TALVUA could effectively reduce the difficulties involved in LESS UVA.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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]. The Van Velthoven VUA is a commonly used technique due to its proven feasibility and safety.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Aim: To investigate the safety, surgical efficiency and patients' ability to recover from urinary continence as a result of a single absorbable running suture versus single-knot running suture for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP). Material and Methods: In a prospective randomised study, we evaluated 162 consecutive patients who underwent LRP with VUA using the single running suture technique or the single-knot running suture technique. Perioperative patients' characteristics, morbidity and urinary continence were analysed. Results: The baseline characteristics were similar between the 2 groups. The single running suture technique was related to decreased anastomotic and total operative times compared with the Van Velthoven technique (13.17 ± 5.74 min vs. 28.49 ± 6.45 min, p = 0.0001, and 174.41 ± 62.97 min and 184.94 ± 46.16 min, p = 0.04, respectively). Overall, urinary continence rates at 3, 6 and 12 months in groups 1 and 2 were 49.4 and 69.1%, 81.5 and 86.4%, and 91.4 and 93.8%, respectively (all with p > 0.05 except the follow-up assessment at 3 months following surgery, p = 0.011). Conclusions: Both methods ensure satisfactory rates of urinary leakage and bladder neck stricture, as well as continence after LRP. However, since the single running suture VUA technique is easier to perform, and the mean anastomosis time of the single running suture VUA technique is shorter than that of the Van Velthoven technique, it appears, therefore, preferable.

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Vesicourethral anastomosis during endoscopic extraperitoneal radical prostatectomy: A prospective comparison between the single-knot running and interrupted technique

Abstract: Both techniques provide satisfactory and similar functional results. However, because of its simplicity and shorter operative time, the single-knot running technique appears preferable.

Cited by 28 publications

References 30 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

Laparoendoscopic Single-Site Urethrovesical Anastomosis Training in an Economical Porcine Model

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

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