Knotless “three‐U‐stitches” technique for urethrovesical anastomosis during laparoscopic radical prostatectomy

Abstract

Abbreviations & AcronymsAbstract: We describe a new technique for urethrovesical anastomosis that consists of placing three "U" stitches of Monocryl 2-0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder's surface using Lapra-Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both "sealed" and "tension free", allowing a quick "welding" of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patients were continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis.

Unidirectional barbed suture for vesicourethral anastomosis during laparoscopic radical prostatectomy

“…However, one of their main limitations is the loss of tension due to suture loosening. To maintain the tension, constant traction by an assistant, repeated tightening of the suture, or the use of clips is needed . Previous reports have already found UBS reduced VUA time by 1.0%–41.7% during RARP .…”

Assessing the Impact of Barbed Suture on Vesicourethral Anastomosis During Minimally Invasive Radical Prostatectomy: A Systematic Review and Meta-analysis

“…To maintain the tension, constant traction by an assistant, repeated tightening of the suture, or the use of clips is needed. 5 Recently, barbed sutures (BS) have been studied and reported extensively in RARP and LRP procedures. This technique allows for knotless sutures with resistance to slippage, obviating the need for assistance, and leading to increased suturing efficiency, especially with tissues under tension.…”

Modified technique for laparoscopic running vesicourethral anastomosis.

“…Our running suture single knot technique further simplifies the reconstruction-making process as only one stitch is used and it takes just six passes through both elements of the anastomosis, with only one knot tied at the end of the procedure. The average time of anastomosis was 9.53 min and it is 2 to 3 times shorter than with other reconstruction techniques being reported [ 9 , 21 – 23 ]. With this method, we found that gentle traction applied to the free end of the stitch at the 5 o'clock position throughout the procedure, in order to prevent anastomosis from loosening and consequently ensuring watertightness of the vesicourethral fixation, is of paramount importance.…”