A Pilot Study on a New Technique for Vesicourethral Anastomosis, Using Two-Knot Running after Laparoscopic Radical Prostatectomy

Abstract

Background: Laparoscopic radical prostatectomy requires a significant learning curve. One area of difficulty is mastering laparoscopic suturing techniques to perform vesicourethral anastomosis. Objective: To compare the efficacy and safety of a new technique for vesicourethral anastomosis using two-knot running. Materials and Methods: Vesicourethral anastomosis was created using two Vicryl 3-0. The first running stitch was placed at the five o’clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out. Proceeding counterclockwise, the running suture was placed from the 5 o’clock to 12 o’clock position. The second running stitch was placed from 5 o’clock to 12 o’clock position, proceeding clockwise. A knot was then tied outside at the 12 o’clock position. Results: The present anastomotic technique had been used in 20 laparoscopic radical prostatectomies. The average time for the anastomosis was 47 minutes, with a range of 38 to 65 minutes. No postoperative urinary leaks occurred, and no clinically evident obstructive symptoms resulted. The urinary continence rate one month after surgery was 20%, and 55% at three months. Conclusion: Two-knot running technique is described as a safe and feasible technique for vesicourethral anastomosis without any experienced assistant. Further studies on a larger group of patients are needed to confirm the preliminary results. Keywords: Prostate cancer; Vesicourethral anastomosis