Comparison of Novel Tissue Apposing Device and Standard Anastomotic Technique for Vesicourethral Anastomoses

Abstract

To evaluate a novel sutureless tissue apposing vesicourethral anastomosis (VUA) device in a porcine model and compare it with standard laparoscopically sutured VUA. Thirty domestic pigs were divided into six groups. In groups 1, 2, and 3, a standard laparoscopic sutured running VUA was performed. In groups 4, 5, and 6, a novel device VUA was performed. In all cases, cystography was completed immediately after completion of the anastomosis and when each pig was killed. At necropsy, the gross findings of the VUA were documented, and each anastomosis was excised en bloc for histopathologic evaluation of healing parameters. In the 30 pigs, 29 (97%) device or sutured VUAs were successfully performed laparoscopically without conversion to an open approach. The mean operative time for the standard and device groups was 87 and 68 minutes, respectively (P = 0.04). The anastomotic time for the standard and device groups was 41 and 12 minutes, respectively (P <0.01). Histopathologic evaluation of the groups at 1 week of follow-up revealed significantly lower fibrosis scores for the novel anastomosis device VUA compared with the standard sutured VUA (median score 1 and 3, respectively; P = 0.04). The evaluation of groups 2 and 5 (3-week survival) and groups 3 and 6 (7-week survival) revealed no significant differences in any of the histopathologic parameters evaluated. The novel device requires little technical skill to deploy and is expeditious, requiring less time than a standard sutured anastomosis. At the 1 week follow-up point, histopathologic examination revealed that the novel device was superior regarding fibrotic reactions.