Use of Lowsley Tractor during Laparoscopic Prostatectomy to Reduce Urethrovesical Anastomotic Tension*

Abstract

We describe a technique to reduce the tension on the urethra while performing the urethrovesical anastomosis during a laparoscopic radical prostatectomy. A Lowsley tractor is passed through the urethral stump, and a single traction stitch is placed in the posterior bladder neck. The first anastomotic stitch is placed through the urethra and bladder neck at the 6 o'clock position but not tied. The traction stitch is then grasped with the wings of the Lowsley and retracted into the urethra, bringing the bladder neck and urethral stump into close proximity. While maintaining traction on the bladder neck, the previously placed 6 o'clock suture is tied. Before releasing the traction stitch from the Lowsley tractor and bladder neck, two additional stitches are placed at the 4 and 8 o'clock positions, completing the posterior anastomosis. Grasping the traction stitch with the Lowsley tractor relieves tension on the posterior urethra and places it on the bladder neck. This prevents urethral tears and gaps in the posterior wall. The anterior portion of the urethra and bladder neck remains open, maintaining vision. Creating a secure posterior anastomosis allows the remaining sutures to be placed under minimal tension. This technique uses an instrument readily available in the urology operating room and facilitates completion of the difficult anastomosis under minimal tension, resulting in a high-quality anastomosis with fewer gaps.