Urethrovesical Anastomosis Using Barbed Suture During Robot-Assisted Radical Prostatectomy

Abstract

Introduction and Objectives: Barbed polyglyconate suture (V-Loc®; Covidien, Mansfield, Massachusetts) was first used for the urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) beginning January 2010. Safety and feasibility were previously demonstrated in 51 patients.1 In this video, we demonstrate the technique of urethrovesical anastomosis with barbed suture and the results of a randomized, controlled trial assessing perioperative and functional outcomes after urethrovesical anastomosis with barbed polyglyconate versus monofilament poliglecaprone in RARP. Methods: After institutional review board approval, 64 patients meeting all inclusion criteria participated in this multi-surgeon prospective, randomized, controlled trial between May and September 2010. Posterior repair and urethrovesical anastomosis during RARP were performed with barbed polyglyconate (n = 33) or monofilament poliglecaprone (n = 31) suture. Primary outcomes were anastomotic (UVA) and posterior reconstruction time. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by patient-administered questionnaire. Results: Posterior reconstruction was performed in 3.3 minutes versus 4.3 minutes (a 23.3% reduction), and UVA was performed in 10.1 minutes versus 13.8 minutes (a 26.8% reduction). The absolute time difference for the two-layer anastomosis was 4.7 minutes. All other perioperative outcomes were equivalent between groups. Patient urinary functional outcomes, including pad usage and leakage rates, were equivalent at 6 weeks. Conclusions: Anastomosis during RARP with barbed polyglyconate suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 25% decrease in anastomotic time with no increase in adverse events, no instances of urinary retention, and equivalent functional outcomes measured by the patient-administered questionnaire. No competing financial interests exist. Runtime of video: 8 mins 22 secs