Laser Welded Vesicourethral Anastomosis in an In Vivo Canine Model: A Pilot Study

Abstract

We evaluated laser welding as an alternative method of forming the vesicourethral anastomosis. Eight dogs underwent open total prostatectomy, including 4 in which the vesicourethral anastomosis was formed by 830 nm. diode laser welding using a chromophore doped albumin solder and 3 or 4 support sutures. The remaining 4 anastomoses were conventionally formed using 8 interrupted sutures. Acute leakage was tested intraoperatively. The anastomosis of 1 animal per group was assessed on postoperative days 3, 5, 7 and 14 by radiography before sacrifice. Each anastomotic specimen was then tested for leak pressure and examined histologically. There were no leaks during intraoperative testing of laser welded or sutured anastomoses. On radiography there were no leaks in the laser welded group. In 1 control there was slight localized leakage. All anastomoses achieved physiological leak pressures of 70 mm. Hg or greater with 3 of the 4 in the laser welded group recording supraphysiological pressures of greater than 200 mm. Hg. While 3 of the 4 laser welded specimens showed evidence of muscle necrosis, there were no other differences in healing in the 2 groups. These short-term results suggest that diode laser welded vesicourethral anastomosis is feasible. This technique has the potential to simplify anastomotic formation in laparoscopic radical prostatectomy, shortening operative time. Diode laser welding in this small cohort created an immediate and ongoing watertight anastomosis and, therefore, it may also be an alternative in open radical prostatectomy cases. Further study is needed to assess long-term effects on healing.