Comparison of Running and Interrupted Vesicourethral Anastomoses in a Porcine Model

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue

OBJECTIVE

To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue.

STUDY DESIGN

Cadaveric ex vivo study.

STUDY POPULATION

Twenty-eight canine bladders with urethra.

METHODS

Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded.

RESULTS

Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381).

CONCLUSION

Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing.

CLINICAL SIGNIFICANCE

This study represents the first step toward laparoscopic radical prostatectomy in dogs.

A comparative study between continuous and interrupted sutures in open pyeloplasty

BACKGROUND

Pelvi-ureteric junction obstruction (PUJO) is one of the common causes of obstructive uropathy dealt by urologists around the globe. The management of PUJO requires surgical intervention and pelvi-ureteral anastomosis is most time-consuming step in surgery and suturing plays a critical role for the good outcome of the surgery.

OBJECTIVE

To assess the outcomes of continuous or interrupted suturing in open pyeloplasties done for PUJ obstruction.

MATERIALS AND METHODS

This comparative study was conducted in the department of Urology in a tertiary care hospital of eastern India. A total of 60 patients with pelviureteric junction obstruction were included as per inclusion and exclusion criteria and divided into two groups depending upon whether continuous (Group A) or interrupted (Group B) suturing was done. Both groups were compared for mean operative time, mean suturing time, duration of post-operative drainage, mean drain output, post-operative hospital stay, postoperative GFR and improvement in GFR.

RESULTS

Out of 60 patients continuous and interrupted suturing was done in 30 patients in both arms. Out of 60 cases there were 46 (76.66%) males and 14 (23.33%) females with a M:F ratio of 1:0.30. The mean age in group A and group B was found to be 30.06 ± 8.28 and 27.63 ± 6.07, respectively. Mean operative time, mean suturing time, duration of post-operative drainage, mean drain output and postoperative hospital stay were found to be higher in interrupted suture group and the difference was found to be statistically highly significant (p < 0.0001). The complication rates and recurrence rates were found comparable in both the cases with no statistically significant difference (p > 0.05).

CONCLUSION

Continuous suturing technique for pyeloplasty is preferable as it is found to have a lower mean operative time, mean suturing time, duration of post-operative drainage, mean drain output and postoperative hospital stay.

A comparison of continuous and interrupted suturing in laparoscopic pyeloplasty

Background:

Laparoscopic pyeloplasty is one of the most common reconstructive procedures performed by urologists. Both continuous and interrupted sutures are being practiced for ureteropelvic anastomosis. The success rate and the complications associated with the suturing technique needs evaluation. We analyzed the results from of our patients who underwent laparoscopic pyeloplasty using both techniques.

Objective:

To review the outcome differences among patients undergoing laparoscopic pyeloplasty regarding suturing technique.

Materials and Methods:

All patients who underwent laparoscopic, transperitoneal dismembered pyeloplasty of the primary pelviureteric obstruction were analyzed. The primary outcome was successful pyeloplasty, as assessed by the resolution of symptoms and T½ <10 minutes. The secondary outcomes were the complication rate and the operative parameters. The difference in the parameters was assessed by Student t test analysis.

Results:

Of the 107 patients we studied, 65 had interrupted suturing and 42 had continuous suturing. The success rate was not significantly different among the 2 groups. The mean suturing time, postoperative drainage volume, postoperative hospital stay, and total cost of the procedure were significantly less in the continuous suturing group.

Conclusion:

The continuous suturing technique is preferred over the interrupted suturing technique for laparoscopic pyeloplasty because the success rates are equal and the postoperative stay, suturing time, drain output, and cost of the procedure are better.

Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

Purpose

To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP).

Materials and Methods

The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured.

Results

Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1±5.3 and 19.3±4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0±3.0 days vs. 12.9±6.4 days, p<0.01). The rate of urinary retention after catheter removal and the rate of bladder neck contracture were not significantly different between the two groups. The rate of urinary continence at 3, 6, 9, and 12 months after RP was also similar in both groups.

Conclusions

Both anastomosis techniques provided similar functional results and a similar rate of postoperative urine extravasation. However, running vesicourethral anastomosis decreased the rate of intraoperative extravasation and time for anastomosis, without increasing the risk of urinary retention or bladder neck contracture.

Overcoming the learning curve for robotic-assisted laparoscopic radical prostatectomy

Robotic-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted in the last few years despite having a prolonged learning curve. This article describes the RALP learning curve, reviews in detail the challenging steps of the operation, describes the authors' RALP technique, and concludes with tips to overcome the learning curve.

A new technique for laparoscopic vesicourethral anastomosis: preliminary report

OBJECTIVES

To introduce a new and easy technique to perform laparoscopic vesicourethral anastomosis with a single-suture, single-knot, running procedure.

METHODS

We have performed 350 laparoscopic radical prostatectomies. In a prospective study, we evaluated a new anastomosis technique in 50 consecutive cases. A multiple knot is prepared at 4 cm from the end of a suture. Then the running suture is started at the bladder neck at 4 o'clock. The posterior plate is maintained open for the first throws, and the suture is pulled only after the third passage at the bladder neck. Then the running suture is completed clockwise and finally tied to the 4-cm tail.

RESULTS

Use of this technique in 50 patients was compared with use of a double running suture in 50 other patients. The 2 groups were comparable. The new procedure was related to a decreased anastomotic time, without complications, with no leak at catheter removal at postoperative day 5 or 6.

CONCLUSIONS

The experience with this original anastomosis is still preliminary, but the results are very promising, and we would like to propose it to laparoscopic urologists.