Urethrovesical Anastomosis Using Barbed Suture During Robot-Assisted Radical Prostatectomy

Abstract

Introduction and Objectives:

Barbed polyglyconate suture (V-Loc^®; Covidien, Mansfield, Massachusetts) was first used for the urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) beginning January 2010. Safety and feasibility were previously demonstrated in 51 patients. ¹ In this video, we demonstrate the technique of urethrovesical anastomosis with barbed suture and the results of a randomized, controlled trial assessing perioperative and functional outcomes after urethrovesical anastomosis with barbed polyglyconate versus monofilament poliglecaprone in RARP.

Methods:

After institutional review board approval, 64 patients meeting all inclusion criteria participated in this multi-surgeon prospective, randomized, controlled trial between May and September 2010. Posterior repair and urethrovesical anastomosis during RARP were performed with barbed polyglyconate (n = 33) or monofilament poliglecaprone (n = 31) suture. Primary outcomes were anastomotic (UVA) and posterior reconstruction time. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by patient-administered questionnaire.

Results:

Posterior reconstruction was performed in 3.3 minutes versus 4.3 minutes (a 23.3% reduction), and UVA was performed in 10.1 minutes versus 13.8 minutes (a 26.8% reduction). The absolute time difference for the two-layer anastomosis was 4.7 minutes. All other perioperative outcomes were equivalent between groups. Patient urinary functional outcomes, including pad usage and leakage rates, were equivalent at 6 weeks.

Conclusions:

Anastomosis during RARP with barbed polyglyconate suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 25% decrease in anastomotic time with no increase in adverse events, no instances of urinary retention, and equivalent functional outcomes measured by the patient-administered questionnaire.

No competing financial interests exist.

Runtime of video: 8 mins 22 secs