Abstract
V-Loc™180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl™ (Ethicon, Somerville, NJ). Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc™180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc™180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident. Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc™180 was associated with improved early continence, this difference was transient.
Highlights
Robotic-assisted laparoscopic prostatectomy (RALP) is a widely utilized, minimally invasive option for the treatment of prostate cancer and, in the short term, has demonstrated similar oncologic outcomes when compared with the open radical prostatectomy [1,2]
All drain creatinine values were consistent with serum and all Jackson Pratt drain (JP) were removed before hospital discharge
There was no detectable difference in the rate of radiographic urine leak between the barbed and non-barbed groups (8.6% vs. 5.7%, p = 0.65)
Summary
Robotic-assisted laparoscopic prostatectomy (RALP) is a widely utilized, minimally invasive option for the treatment of prostate cancer and, in the short term, has demonstrated similar oncologic outcomes when compared with the open radical prostatectomy [1,2]. Several UVA techniques have been described including a running suture anastomosis, interrupted suture anastomosis, and use of a Lapra-Ty (Ethicon Endosurgery, Cincinnati, Ohio) to secure the posterior anastomosis [4,5] Drawbacks to these techniques include slippage and relaxation of the suture and Lapra-Ty clip erosion. An absorbable unidirectional barbed suture has become available (V-LocTM180, Covidien, Mansfield, MA) (Figure-1). This suture has been used for skin and soft tissue closures, gynecologic procedures, and bowel anastomosis in a porcine rate, symptomatic bladder neck contractures, and urinary continence in patients undergoing RALP with barbed versus non-barbed suture
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