ENDOUROLOGY Vesicourethral anastomosis using V-Loc™ barbed suture during 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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Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience

International Urology and Nephrology ◽

10.1007/s11255-011-9967-0 ◽

2011 ◽

Vol 44 (1) ◽

pp. 125-132 ◽

Cited By ~ 24

Author(s):

Ashok K. Hemal ◽

Mayank Mohan Agarwal ◽

P. Babbar

Keyword(s):

Radical Prostatectomy ◽

Barbed Suture ◽

Initial Experience ◽

Robot Assisted ◽

Vesicourethral Anastomosis

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Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture

Canadian Urological Association Journal ◽

10.5489/cuaj.641 ◽

2013 ◽

Vol 5 (3) ◽

pp. 188

Author(s):

Kevin C. Zorn ◽

Hugues Widmer ◽

Jean-Baptiste Lattouf ◽

Dan Liberman ◽

Naeem Bhojani ◽

...

Keyword(s):

Radical Prostatectomy ◽

Barbed Suture ◽

Knot Tying ◽

Robot Assisted ◽

Suture Tension ◽

Vesicourethral Anastomosis ◽

Watertight Closure ◽

The Right ◽

Cas A ◽

Posterior Reconstruction

Purpose: Our purpose was to describe the safety and feasibility ofa running posterior reconstruction (PR) integrated with continuousvesicourethral anastomosis (VUA) using a novel self-cinchingunidirectional barbed suture in robot-assisted radical prostatectomy(RARP).Methods: Between March and October 2010, 30 consecutivepatients with organ-confined prostate cancer underwent RARP byan experienced single surgeon (KCZ). Upon completion of radicalprostatectomy, urinary reconstruction was carried out using2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The lefttail of the suture was initially used for PR (starting at 5-o’clockand ran to re-approximate the retrotrigonal layer to the rectourethralis)followed by left-sided VUA (from 6- to 12-o’clock), whilethe right-sided suture completed the right-sided VUA. Assuranceof watertight closure with an intraoperative 300 cc saline visualcystogram was performed in all cases prior to case completion.Perioperative outcomes and 30-day complications were recorded.Results: All anastamoses were performed without assistance andwithout knot tying. Median time for nurse setup and urinary reconstructionwas 40 seconds (interquartile range [IQR] 25-60) and14.6 min (IQR 10-18), respectively. The need to readjust suturetension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati,OH) to establish watertight closure was observed in 2 cases (7%).No patient had clinical urinary leak and there was no urinary retentionafter catheter removal on mean postoperative day 5 (IQR 4-6).Conclusions: Our clinical experience with a novel technique usingthe interlocked V-Loc suture during RARP for both PR and anastomosisappears to be safe and efficient. Using the barbed sutureprevents slippage and eliminates the need for bedside assistanceto maintain suture tension or knot tying, thus assuring watertighttissue closure.Objectif : Notre but était de décrire l’innocuité et la faisabilitéd’une reconstruction postérieure (RP) intégrée à une anastomosevésico-urétrale continue à l’aide de la nouvelle technique de sutureavec fils barbelés unidirectionnels et ancrage automatique aprèsprostatectomie radicale assistée par robot (PRAR).Méthodologie : Entre mars et octobre 2010, 30 patients consécutifsatteints d’un cancer de la prostate confiné à la glande ont subi unePRAR effectuée par un chirurgien expérimenté (KCZ). Après laprostatectomie radicale, une reconstruction urinaire a été entrepriseà l’aide de 2 sutures 3-0 de 6 pouces sans noeud par le dispositifV-Loc 180. L’extension gauche de la suture a d’abord été utiliséepour la PR (en commençant à 5 heures et en poursuivant pourrapprocher la couche rétrotrigonale du muscle recto-urétral) etsuivie d’une anatostomose vésico-urétrale du côté gauche (de 6 à12 heures), alors que la partie droite de la suture a permis de terminerl’anastomose vésico-urétrale droite. Une fermeture hermétiquepar cystogramme visuel intraopératoire avec 300 mL de solutionsalée dans tous les cas a été réalisée avant la fin de l’intervention.Les résultats peropératoires et les complications émergeant pendantles 30 jours suivants ont été consignés.Résultats : Toutes les anastomoses ont été effectuées sans aide etsans noeud. Le temps médian pour la préparation par l’infirmièreet la reconstruction urinaire était de 40 secondes (écart interquartile[EIQ] 25-60) et de 14,6 minutes (EIQ 10-18), respectivement.Dans 2 cas (7%), on a eu besoin de rajuster la tension des pointsde suture ou de placer des agrafes LapraTy (Ethicon Endo-Surgery,Cincinnati, OH) pour assurer une fermeture hermétique. Aucunpatient n’a présenté de fuite urinaire clinique ni aucune rétentionurinaire après le retrait du cathéter en moyenne 5 jours aprèsl’opération (EIQ 4-6).Conclusions : Selon notre expérience clinique, cette nouvelle techniquede fermeture de plaie par le dispositif V-Loc pour une PRARavec anastomose semble sans danger et efficace. L’usage des fils barbelés empêche le glissement et élimine le besoin d’aide afind’assurer la bonne tension des points de suture ou de noeuds, etassure une fermeture hermétique des tissus.

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