Minimally Invasive Device for Rapid Urethrovesical Anastomosis

Abstract

Radical prostatectomy is a common treatment for patients with prostate cancer [1]. The current surgical technique for radical prostatectomies requires dividing the urethra from the bladder in order to aid the removal of the prostate [2]. At the end of a prostatectomy, the urethra is reconnected to the bladder in a procedure known as urethrovesical anastomosis (UVA) involving suturing the urethra to the bladder with bioabsorbable sutures. This procedure is commonly done first by reconstructing the posterior aspect of the rhabdosphincter, using this reconstruction to bring together the bladder and the urethral stump and lastly performing a running suture to avoid multiple knot tying. UVA is the most challenging and time consuming of the radical prostatectomy procedure due to the constrained surgical field, the proximity of the external urethral sphincter, and the complexity of suturing on very small tubular structures. These have limited the surgical time for the UVA for an experienced surgeon to 15 min [3]. Most current suturing or stapling devices on the market are not designed for UVA and, therefore, lack crucial features necessary for performing the procedure, for example placing the urethra and bladder neck in contact to insert the sutures. One of the challenges in creating a device to automatically perform UVA is that no non-absorbable structures can remain in the urethra or bladder as interaction with urea in the urine can result in stone formation and further complications.