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Vol. 36. Issue 2.
Pages 69-74 (February 2012)
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Vol. 36. Issue 2.
Pages 69-74 (February 2012)
Original article
Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot-assisted radical prostatectomy
Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot
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R. Valeroa,b,??
Corresponding author
rairvalero@gmail.com

Corresponding author.
, O. Schatloffa, S. Chauhana, Y. HwiiKoa,c, A. Sivaramana, R.F. Coelhoa,d, K.J. Palmera,b, H. Davilab, V.R. Patela
a Instituto de Robótica Global, Hospital Celebration Health de Florida, Celebration, FL, USA
b Servicio de Urología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
c Departamento de Urología, Facultad de Medicina de la Universidad de Corea, Seúl, Republic of Korea
d Servicio de Urología, Hospital das Clinicas de la Facultad de Medicina de la Universidad de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Table 1. Comparison of barbed closure devices.
Abstract
Background

The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis.

Objective

To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture.

Material and methods

The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture.

Results

All cases were finished successfully without major complication or conversion to laparoscopic or open surgery.

Conclusion

The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.

Keywords:
Barbed suture
Robot assisted radical prostatectomy
Knotless tissue-closure device
Urethrovesical anastomosis
Resumen
Antecedentes

La anastomosis uretrovesical es un paso exigente de la prostatectomía radical asistida por robot (PRAR). La imposibilidad de lograr una anastomosis hermética se asocia con la pérdida urinaria postoperatoria y sus consecuencias, que incluyen el íleo paralítico, la cateterización prolongada, la peritonitis urinaria y posiblemente la reintervención. La sutura barbada bidireccional es una tecnología nueva que puede llegar a mejorar la calidad de la anastomosis uretrovesical.

Objetivo

Presentar nuestra técnica quirúrgica de la anastomosis uretrovesical, la reconstrucción del cuello vesical y la reconstrucción posterior utilizando una sutura barbada bidireccional.

Materiale y métodos

La reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral se realizaron con una sutura barbada monofilamento bidireccional absorbible sintético 2-0.

Resultados

Todos los casos se completaron con éxito, sin complicaciones graves o conversiones a cirugía laparoscópica o abierta.

Conclusión

Los autores cambiamos con éxito la técnica PRAR para aprovechar las propiedades de la sutura barbada bidireccional. Estudios comparativos que evalúen los resultados objetivos, como el índice de pérdida y el tiempo de la operación, son necesarios para establecer definitivamente los beneficios de este dispositivo en comparación con el monofilamento absorbible tradicional.

Palabras clave:
Sutura barbada
Prostatectomía radical asistida por robot
Dispositivo de cierre de tejidos sin nudos
Anastomosis uretrovesical

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