Abstract
Background and Purpose:
With widespread implementation of posterior rhabdosphincter reconstruction (RSR) followed by urethrovesical anastomosis (UVA), reconstruction has become a significant portion of robot-assisted laparoscopic prostatectomy (RALP). Successful anastomosis can be measured by time for reconstruction and the absence of urinary leak. We prospectively evaluated the experience of a single surgeon (KKB) in using the V-Loc™ wound closure device for the posterior RSR and UVA, and compared it with a standard reconstruction and anastomosis.
Patients and Methods:
A total of 84 patients divided into two groups underwent RALP, undergoing RSR and UVA using a Van Velthoven technique with the V-Loc or with a standard 3-0 monofilament suture. The primary end point was the time to complete RSR, UVA, and the total reconstruction. As a secondary end point, the clinical evidence of an anastomotic leak was also documented.
Results:
The mean RSR, UVA, and total times were 9, 18, and 27 minutes for the control group, and 6, 12 and 18 minutes for the V-Loc group, respectively. The time differences between the two groups for RSR, UVA, and total time were 3 minutes (P<0.01), 6 minutes (P<0.01), and 9 minutes (P<0.001), respectively. There was no clinical evidence of anastomotic leak in either group. Continence recovery was equivalent between the groups at 6 weeks and 6 months. At a 9-month follow-up, no patients in either group had a clinical UVA stricture necessitating intervention.
Conclusions:
The V-Loc suture is associated with a significantly shorter time for the RSR and UVA compared with the traditional suture and is not associated with a higher incidence of clinical urinary leak; however, a larger randomized study with long-term follow-up is necessary to confirm these results.
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