Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

Abstract

INTRODuCTIONRobotic-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). The urethrovesical anastomosis (UVA) is a technically challenging aspect of RALP (3). Several UVA techniques have been described including a running suture anastomosis, interrupted suPurpose: 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). Materials and Methods: 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. Results: 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. Conclusions: 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.

Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta‐analysis

“…A total of 12 studies, including three RCTs [9–11] (211 patients), nine cohort studies [12–20] (698 patients), and no case–control studies were found to fulfill the eligibility criteria. Table 1 presents the baseline characteristics of all studies (Figure 1).…”

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

“…Meta-analysis of the remaining 5 studies 10,11,14,17,19 indicated no significant differences in postoperative urinary leak (OR, 0.57; 95% CI, 0.20-1.67; Bladder Neck Stricture and Anastomosis Stricture Substantial heterogeneity was observed across the set of 5 studies reporting on bladder neck stricture and anastomosis stricture, which prohibited a meta-analysis. In the study by Polland et al, 16 …”

“…Ultimately, a total of 10 studies (comprising 378 cases and 369 controls) were included in our metaanalysis. [10][11][12][13][14][15][16][17][18][19] All the studies were published within the last 4 years, reflecting the increased application of this technique. Three studies were RCTs (LE, 2b) comparing BS and conventional sutures.…”

“…24 Potential causes include increased operative blood loss, absence of mucosal eversion, poor UVA, ischemia of bladder neck tissue, extended length of urinary catheterization, and urinary infection. 14,24,25 Excessive intraoperative bleeding can obscure the vision of the operative field and may lead to imprecise dissection and poor suture of tissue planes. BS with minimal tension and less foreign body reaction may contribute to less inflammation, scar formation, and tissue ischemia.…”

Laparoscopic gastrointestinal anastomoses using knotless barbed absorbable sutures are safe and reproducible: a single-center experience with 242 patients

“…To date, the efficacy and safety of this novel suture in gynecologic (31)(32)(33)(34)(35), urologic (36)(37)(38) and orthopedic surgery (39) have been reported. With respect to digestive surgery though, only a few studies, including our 2011 report of the first use of barbed sutures in gastrointestinal anastomoses, have proven the safety and suitability of barbed sutures in terms of anastomotic leakages or stenosis, but there have been no prospective studies for bowel anastomosis following LG for malignant disease.…”