Predictive Validation of a Robotic Virtual Reality Simulator: The Tube 3 module for Practicing Vesicourethral Anastomosis in Robot-Assisted Radical Prostatectomy

Introduction: We aimed to evaluate urinary continence recovery following robot-assisted radical prostatectomy (RARP) using monofilament poliglecaprone (Monocryl®) suture vs. barbed suture (V-LocTM 180) during vesicourethral anastomosis. Methods: In this prospective, observational cohort, data were collected on 322 consecutive patients. All patients underwent continuous, bidirectional, single-layer running anastomosis with either 3.0-monofilament suture (n=141) or 3.0 barbed suture (n=181). The primary outcome was continence recovery defined as time to 0 pad at one, three, six, 12, and 24 months following surgery. Results: Continence rates were significantly better with monofilament VUA at all followup time points up to one year. Median time to continence was one month vs. five months in the monofilament group vs. barbed group, respectively (p<0.001). Continence rates in monofilament suture vs. barbed group at one, three, six, 12, and 24 months were 56% vs. 26% (p<0.001), 73% vs. 36.4% (p<0.001), 84.4% vs. 60.2% (p<0.001), 90.8% vs. 71.9% (p<0.001), and 93.5% vs.87.1% (p=0.1), respectively. Anastomosis time was shorter in the barbed group, with a median of 23 vs. 30 utes (p<0.001). Patients anastomosed with Monocryl suture had smaller prostate weight (median 42.5 g vs. 50 g; p<0.001) and harbored less advanced disease (T2a‒c 76.6 vs. 74%; p=0.01) relative to patients treated with V-Loc 180 suture. However, in a multivariate Cox logistic regression analyses, independent predictors of continence recovery were suture type (hazard ratio [HR] 53; 95% confidence interval [CI] 0.41‒0.68; p=0.02] and prostate size (HR 0.99; 95% CI 0.98‒0.99; p<0.001). Conclusions: Barbed VUA contributed to delayed continence recovery compared to monofilament poliglecaprone suture during the first year post-RARP. However, no statistically significant difference was recorded at two years post-RARP. These results warrant special attention, especially with the widespread use of barbed suture in recent years.

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Psychological factor, metacognition, is associated with the advantage of suturing techniques acquired on a virtual reality simulator of robot-assisted surgery

International Journal of Urology ◽

10.1111/iju.12286 ◽

2013 ◽

Vol 21 (3) ◽

pp. 349-350 ◽

Cited By ~ 3

Author(s):

Jun Teishima ◽

Minoru Hattori ◽

Akio Matsubara

Keyword(s):

Virtual Reality ◽

Psychological Factor ◽

Virtual Reality Simulator ◽

Robot Assisted ◽

Suturing Techniques ◽

Robot Assisted Surgery

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Effect of a novel technique of posterior reconstruction of pubourethralis on ‘early’ return of continence after robot assisted radical prostatectomy (RARP): A comparative study

Urologia Journal ◽

10.1177/03915603211007052 ◽

2021 ◽

pp. 039156032110070

Author(s):

Malik Abdul Rouf ◽

Venkatesh Kumar ◽

Anshuman Agarwal ◽

Mahender Sharma ◽

Suresh Kumar Rawat ◽

...

Keyword(s):

Radical Prostatectomy ◽

Control Group ◽

Study Group ◽

Robot Assisted ◽

Novel Technique ◽

Early Return ◽

Number Of Patients ◽

Vesicourethral Anastomosis ◽

Posterior Reconstruction ◽

And Control

Objective: To study the effect of a novel technique of posterior reconstruction of pubourethralis on early return of continence after robot assisted radical prostatectomy (RARP). Materials and methods: The study included 206 patients of organ confined prostate cancer managed at our centre between March 2014 and December 2018.The patients were randomly distributed into two comparable groups with respect to age, height, weight and BMI, with 100 patients in control and 106 patients in study group. After standard excision of the specimen, the posterior reconstruction in the form of Rocco stitch was done in control group while in addition to Rocco stitch pubourethralis was approximated posteriorly in midline at the proposed site of vesicourethral anastomosis in study group. Continence was defined as the need to use 0–1 pad in 24 h. The data was collected on day 0, 3, 7, 15, 30, 90 and 180 after removal of catheter. Results: At day zero, 3,7, 15, 30, 90 and 180 days after catheter removal continence rates (⩽1 pad usage per day) were observed to be 18.8% versus 0%, 22.6% versus 0%, 50.9% versus 5%, 72.6% versus 20%, 84.9 versus 32%, 97.1% versus 83%, and 97.1% versus 91% in the study and control group respectively. Conclusion: Despite small number of patients in this study the results with respect to early return of continence are encouraging in the reconstruction group and there by in favour of this technique .Furthermore the technique is easily reproducible and may be seen as one more additional step to be applied in order to enhance the recovery of continence after RARP. However it is necessary to further validate the efficacy of this procedure through multicenteric controlled trials.

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