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Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Chavali JS, Geskin A, Kaouk J. Vesicourethral Anastomosis in Transvesical Single-Port Robotic Radical Prostatectomy: A Technical Description and Perioperative Outcomes. J Endourol 2023; 37:1001-1011. [PMID: 37463019 DOI: 10.1089/end.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: To describe the technical evolution and perioperative outcomes of vesicourethral anastomosis (VUA) in transvesical (TV) single-port robot-assisted radical prostatectomy (SP-RARP). Materials and Methods: A retrospective review was performed on 189 patients who underwent TV SP-RARP by a single surgeon using the purpose-built SP robotic platform. VUA was completed from within the bladder using two unidirectional V-loc sutures in a continuous, semicircular manner with greater emphasis posteriorly. The most recent 20 cases of TV SP-RARP were selected to evaluate the anastomosis technique and to compare the perioperative outcomes with the first 20 cases of TV SP-RARP performed at our institution. Demographic and clinical data were collected from the prospectively maintained database and statistical analysis was performed. Results: VUA was effectively completed in all cases using the aforementioned technique without any suture breaks, need for conversion, or evidence of intraoperative complication, including urine leak. Marked improvement in the learning curve was observed, which translated to significant reduction in the number of VUA sutures (median: 13 vs 15, p < 0.05) and faster anastomosis time (median: 19.1 vs 33.5 minutes, p < 0.05). The number of anastomotic sutures did not correlate with the prostatectomy specimen weight or volume, especially with both being significantly greater in the latest cases (median weight: 45.1 vs 37.6 g, p < 0.05; median volume: 40.9 vs 36.2 mL, p < 0.05). Postoperative outcomes were favorable with immediate continence achieved in 51.3% of our total cohort and with no patients demonstrating evidence of bladder neck contracture. Conclusion: We provided a detailed technical description of VUA in TV SP-RARP. The improved maneuverability of the SP robotic platform allowed for unique movements to facilitate suture placements from within the confined space of the bladder. The learning curve of a single surgeon was shown in our study, which resulted in notable reduction in the number of sutures, faster anastomosis time, and improved perioperative outcomes.
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Affiliation(s)
- Nicolas A Soputro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ethan L Ferguson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roxana Ramos-Carpinteyro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaya S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Albert Geskin
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Xu S, Zhao X, He Z, Yang X, Ma J, Dong F, Zang L, Fingerhut A, Zhang L, Zheng M. A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis. Front Surg 2022; 9:963597. [PMID: 36406345 PMCID: PMC9666673 DOI: 10.3389/fsurg.2022.963597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background Laparoscopic colectomy is widely practiced for colon cancer, but many variations exist for anastomosis after laparoscopic colon cancer radical resection. Method We retrospectively analyzed 226 patients who underwent laparoscopic-assisted radical resection for left colon cancer with knotless hand-sewn end-to-end anastomosis (KHEA) technique with barbed V-loc™ suture material and compared perioperative outcomes, safety, and efficacy to those undergoing stapled anastomosis from 2010 to 2021. Results After the 1:2 propensity score matching, 123 participants with similar preoperative characteristics (age, body mass index, TNM stage, and tumor location) were enrolled in the study: 41 in the KHEA and 82 in the stapler group. Statistically significant differences were found in time to accomplish the anastomosis (mean 7.9 vs. 11.9 min, p < 0.001) and hospital costs (mean 46,569.71 vs. 50,915.35 CNY, p < 0.05) that differed between the KHEA and stapler group, respectively. No statistically significant difference was found in the mean delay to bowel function recovery (2.6 vs. 2.7 days, p = 0.466), duration of hospital stay (8.6 vs. 7.9 days, p = 0.407), or rate of postoperative complications (14.6% vs. 11.0%, p = 0.563). Anastomotic leakage occurred in 11 patients: 5 (12.2%) vs. 6 (7.3%) (p > 0.05) in the KHEA and stapler group, respectively. Conclusion KHEA is feasible and safe for anastomosis after laparoscopic left hemicolectomy. The KHEA technique could reduce operation time and hospital costs with complication rates comparable to stapling.
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Affiliation(s)
- Shining Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Dong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Section for Surgical Research and Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Luyang Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Minhua Zheng Luyang Zhang
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Minhua Zheng Luyang Zhang
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Ou YC, Lu CH, Lin YS, Huang LH, Weng WC, Hsu CY, Tung MC. Complications of robotic-assisted laparoscopic radical prostatectomy: Experience Sharing from 2000 cases involving a single surgeon. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports: a pilot study. Wideochir Inne Tech Maloinwazyjne 2021; 16:715-721. [PMID: 34950267 PMCID: PMC8669979 DOI: 10.5114/wiitm.2021.103946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Radical cystectomy is one of the most complex operations in urology, in which orthotopic ileal neobladder construction is an important part. With the development of laparoscopic instruments and surgical techniques, laparoscopic radical cystectomy has been shown to be feasible and safe and has obvious benefits. However, intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is rarely reported. Aim To share our experience in intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports in patients with bladder cancer and explore the feasibility, safety and benefits of this procedure. Material and methods From January 2018 to December 2019, 32 patients with bladder cancer underwent laparoscopic intracorporeal radical cystectomy and orthotopic neobladder. In this article, complete intracorporeal U-shaped ileal neobladder construction with three ports will be presented. Results The median estimated intraoperative blood loss was 130 ml. The median total operative time was 270 min, and ileal reservoir construction and anastomosis required 93 min. The median time to recovery of intestinal function following the operation was 3 days. At a median follow-up of 13 months, 8 patients had hydronephrosis. Conclusions Intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is feasible and safe. This procedure is less invasive and is highly beneficial for patients with difficulty with anastomosis of the ileum and urethra due to high mesenteric tension.
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Zheng L, Yin X, Liu H, Wang S, Hu J. Case Report: Small Bowel Obstruction Owing to Self-Anchoring Barbed Suture Device After TAPP Repair. Front Surg 2021; 8:646091. [PMID: 33644112 PMCID: PMC7906226 DOI: 10.3389/fsurg.2021.646091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 01/30/2023] Open
Abstract
Groin hernioplasty is the most performed intervention in the adults worldwide, the minimally invasive inguinal hernia repair techniques widely used by surgeons today are transabdominal preperitoneal patch plasty (TAPP) and total extraperitoneal patch plasty (TEP). We report a 62-year-old man with bowel obstruction caused by the use of self-anchoring barbed suture to close the peritoneum 3 days after TAPP. Surgeons using the barbed suture should be alert to this possibility when encountering this complication of intestinal obstruction, so as to avoid more serious consequences.
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Affiliation(s)
- Longbo Zheng
- Department of Gastroenterology Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangyi Yin
- Department of Gastroenterology Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huasheng Liu
- Department of Gastroenterology Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shouguang Wang
- Department of Gastroenterology Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jilin Hu
- Department of Gastroenterology Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases. J Robot Surg 2020; 15:651-660. [PMID: 33040249 DOI: 10.1007/s11701-020-01157-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes.
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Yilmaz O, Tanriverdi HI, Cayirli H, Ertan P, Sencan A, Genc A, Taneli C. Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children. J Pediatr Urol 2019; 15:660.e1-660.e5. [PMID: 31474504 DOI: 10.1016/j.jpurol.2019.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/31/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures. MATERIAL AND METHOD We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-LocTM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion. RESULTS The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months. CONCLUSION In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.
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Affiliation(s)
- O Yilmaz
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey.
| | - H I Tanriverdi
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey
| | - H Cayirli
- Ege University, Faculty of Medicine, Dept. of Pediatric Surgery, Izmir, Turkey
| | - P Ertan
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Nephrology, Manisa, Turkey
| | - A Sencan
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey
| | - A Genc
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey
| | - C Taneli
- Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey
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Rajih E, Meskawi M, Alenizi AM, Zorn KC, Alnazari M, Borhan W, Zanaty M, El-Hakim A. Long-term urinary functional outcome of vesicourethral anastomosis with bidirectional poliglecaprone (Monocryl ®) vs. barbed polyglyconate suture (V-Loc TM 180) in robot-assisted radical prostatectomy. Can Urol Assoc J 2019; 14:E74-E79. [PMID: 31599716 DOI: 10.5489/cuaj.5959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate urinary continence recovery following robot-assisted radical prostatectomy (RARP) using monofilament poliglecaprone (Monocryl®) suture vs. barbed suture (V-LocTM 180) during vesicourethral anastomosis (VUA). METHODS In this prospective, observational cohort, data were collected on 322 consecutive patients. All patients underwent continuous, bidirectional, single-layer running anastomosis with either 3.0 monofilament suture (n=141) or 3.0 barbed suture (n=181). The primary outcome was continence recovery defined as time to 0 pad at one, three, six, 12, and 24 months following surgery. RESULTS Continence rates were significantly better with monofilament VUA at all followup time points up to one year. Median time to continence was one month vs. five months in the monofilament group vs. barbed group, respectively (p<0.001). Continence rates in monofilament suture vs. barbed group at one, three, six, 12, and 24 months were 56% vs. 26% (p<0.001), 73% vs. 36.4% (p<0.001), 84.4% vs. 60.2% (p<0.001), 90.8% vs. 71.9% (p<0.001), and 93.5% vs.87.1% (p=0.1), respectively. Anastomosis time was shorter in the barbed group, with a median of 23 vs. 30 minutes (p<0.001). Patients anastomosed with Monocryl suture had smaller prostate weight (median 42.5 g vs. 50 g; p<0.001) and harbored less advanced disease (T2a-c 76.6 vs. 74%; p=0.01) relative to patients treated with V-Loc 180 suture. However, in a multivariate Cox logistic regression analyses, independent predictors of continence recovery were suture type (hazard ratio [HR] 53; 95% confidence interval [CI] 0.41-0.68; p=0.02] and prostate size (HR 0.99; 95% CI 0.98-0.99; p<0.001). CONCLUSIONS Barbed VUA contributed to delayed continence recovery compared to monofilament poliglecaprone suture during the first year post-RARP. However, no statistically significant difference was recorded at two years post-RARP. These results warrant special attention, especially with the widespread use of barbed suture in recent years.
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Affiliation(s)
- Emad Rajih
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Malek Meskawi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Abdullah M Alenizi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Walaa Borhan
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Marc Zanaty
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Assaad El-Hakim
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
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Giri V, Yadav SS, Tomar V, Jha AK, Garg A. Retrospective comparison of outcomes of laparoscopic pyeloplasty using barbed suture versus nonbarbed suture: A single-center experience. Urol Ann 2019; 11:410-413. [PMID: 31649463 PMCID: PMC6798306 DOI: 10.4103/ua.ua_123_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: laparoscopic pyeloplasty is an important tool in urology armamentarium. The most important & also the difficult part of this surgery is intracorporial suturing and knotting. There are only a few reports of knotless Barbed sutures for upper tract reconstruction. We report the comparative outcomes of Laparoscopic Pyeloplasty with barbed suture vs non barbed sutures used for uretero-pelvic anastomosis. Materials and Methods: We retrospectively reviewed patients' records that underwent Laparoscopic pyeloplasty at our Institution from January 2013 to May 2014. Total 37 patients were underwent LP in this period. Whole of the procedure was same as conventional LP except suture material. 3-0 barbed suture was used in 21 patients and 3-0 vicryl used in 16 patients for uretero-pelvic anastomosis and continuous suturing technique was employed. Patients' demographics, total operative time, intracorporial suturing time, post operative complications, symptoms & renal isotope scan were recorded. Results: Average total operative time was significantly less in barbed suture group vs vicryl group (162 vs 208 minutes) (p=0.0811). Average time taken for intracorporial suturing was 31.2 minutes vs 70 minutes (p=0.0576). 1 patient developed post operative urine leak which persisted for 5 days in barbed group (4.76 %) vs no leak in vicryl group. Most common complication was UTI presented in 2 patients (9.5 %) vs 2 in vicryl (12.5%). JJ stent was removed at 4 weeks. Median follow up was 3 months with 7 patients lost to follow up. None of the patients found to have obstructive drainage or deterioration of split function on follow up isotope renogram at 3 months. Conclusions: In this study, Laparoscopic pyeloplasty with barbed suture has acceptable outcome when compared to conventional non barbed suture on short term basis. Laparoscopic Pyeloplasty with barbed suture can potentially become the standard approach in near future.
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Affiliation(s)
- Vikas Giri
- Department of Urology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Department of Urology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Vinay Tomar
- Department of Urology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Amit K Jha
- Department of Urology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Amit Garg
- Department of Urology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Cakici OU, Canda AE. Bidirectional Barbed Only vs Poliglecaprone Suture with Rhabdosphincter Reconstruction for Urethrovesical Anastomosis During Robotic Radical Prostatectomy: Does It Make Any Difference? J Endourol 2018; 32:944-949. [PMID: 30056748 DOI: 10.1089/end.2018.0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We investigated the use of bidirectional barbed suture only vs poliglecaprone suture with posterior rhabdosphincter reconstruction for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) on cystographic leakage, duration of catheterization, and early urinary continence. MATERIALS AND METHODS Bidirectional double-armed barbed suture only was used for UVA (n = 50) in Group 1. Two 3/0 poliglecaprone 25 sutures were tied to each other to form a double-armed suture used for UVA with posterior rhabdosphincter reconstruction in Group 2 (n = 50). Groups were similar regarding patient demographics and operative parameters. Groups were compared regarding leakage on cystography, duration of urethral catheterization after RARP, immediate urinary continence (continence at the time of urethral catheter removal), and continence rates at first and third-month follow-up. RESULTS Leakage on cystography was detected in 4 (8%) and 10 (20%) of the patients in Group 1 and 2, respectively (p = 0.08). Urinary catheter removal duration was 7.8 and 8.5 days in Group 1 and 2, respectively (p = 0.1). Immediate urinary continence was achieved in 38 (76%) and 20 (40%) of the patients in Group 1 and 2, respectively (p = 0.002). Urinary continence in first-month follow-up was achieved in 46 (92%) and 38 (76%) of the patients in Group 1 and 2, respectively (p = 0.02). Urinary continence in third-month follow-up was achieved in 48 (96%) and 47 (94%) of the patients in Group 1 and 2, respectively (p = 0.64). Mean UVA time was 16.8 and 21.2 minutes, respectively, in Group 1 and 2 (p < 0.001). CONCLUSIONS Because of our experience, use of a barbed suture for UVA during RARP seems to lead to better immediate and early (first month) urinary continence rates and a shorter UVA time.
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Affiliation(s)
- Ozer Ural Cakici
- 1 Department of Urology, Yenimahalle Training and Research Hospital , Ankara, Turkey
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Bracale U, Merola G, Cabras F, Andreuccetti J, Corcione F, Pignata G. The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study. Surg Innov 2018; 25:267-273. [DOI: 10.1177/1553350618765871] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. A totally laparoscopic right colectomy could be perceived as a more challenging procedure over a laparoscopic-assisted right colectomy owing to the difficulty of intracorporeal anastomosis and the closure of the enterotomy. The aim of this study is to evaluate the safety and efficacy of the barbed auto-locking absorbable suture for the closure of an anastomotic stapler-access enterotomy during a totally laparoscopic right colectomy. Methods. From January 2010 to April 2016, data from patients who had undergone a laparoscopic right colectomy in 2 different departments of 2 institutions (the Department of General and Minimally Invasive Surgery, San Camillo Hospital in Trento and the Department of Surgical Specialties and Nephrology, University Federico II in Naples) were retrospectively analyzed. We compared the data of patients in whom the stapler-access enterotomy was closed through a conventional absorbable suture (Group A), with the data of patients in whom a stapler-access enterotomy was closed through a V-Loc 180 suture (Group B). Biometric features and intraoperative and postoperative data were collected and analyzed. Results. The 2 groups (Group A: 40 patients; Group B: 40 patients) were comparable for biometric features and postoperative outcomes. The anastomosing time was lower in Group B. A statistically significant difference was noted in the mean operative time between Groups A and B (Group A = 134.92 ± 34.17; Group B = 120.92 ± 23.27, P = .035). Only one anastomotic leakage per group was recorded, each treated with an anastomosis redo. During the reoperations, we find in both groups an intact stapler-access enterotomy. Conclusion. On retrospective analysis, barbed suture appears to be safe and efficient for closure of the stapler-access enterotomy during totally laparoscopic right colectomy.
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Affiliation(s)
| | - Giovanni Merola
- University Federico II of Naples, Naples, Italy
- San Camillo Hospital, Trento, Italy
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Argun OB, Tuna MB, Doganca T, Obek C, Mourmouris P, Tufek I, Erdogan S, Cetinel B, Kural AR. Prevention of Urethral Retraction with Stay Sutures (PURS) During Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study. J Endourol 2018; 32:125-132. [DOI: 10.1089/end.2017.0460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omer Burak Argun
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Tunkut Doganca
- Department of Urology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Can Obek
- Department of Urology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Panagiotis Mourmouris
- 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens, Athens, Greece
| | - Ilter Tufek
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Sarper Erdogan
- Department of Public Health and Occupational Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bulent Cetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Rıza Kural
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Feroci F, Giani I, Baraghini M, Romoli L, Zalla T, Quattromani R, Cantafio S, Scatizzi M. Barbed versus traditional suture for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis: a case–control study. Updates Surg 2017; 70:433-439. [DOI: 10.1007/s13304-017-0502-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
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Varca V, Benelli A, Pietrantuono F, Suardi N, Gregori A, Gaboardi F. A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy. Urologia 2017; 84:0. [PMID: 28665458 DOI: 10.5301/uj.5000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. MATERIALS AND METHODS This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. RESULTS Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only one patient in group C developed a bladder neck contracture 6 months after the procedure, but he underwent adiuvant radiotherapy after surgery. CONCLUSIONS Our data suggest that the use of Dextérité needle holder significantly reduces operative time of VUA completion and reduces the incidence of urinary leakage in laparoscopic surgeons at the beginning of the learning curve.
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Affiliation(s)
- Virginia Varca
- Department of Urology, G. Salvini Hospital, Milan - Italy
| | - Andrea Benelli
- Department of Urology, G. Salvini Hospital, Milan - Italy
| | | | | | - Andrea Gregori
- Department of Urology, G. Salvini Hospital, Milan - Italy
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Tsukada T, Kaji M, Kinoshita J, Shimizu K. Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures. JSLS 2017; 20:JSLS.2016.00023. [PMID: 27493467 PMCID: PMC4949351 DOI: 10.4293/jsls.2016.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background and Objectives: Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes. Methods: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection. Results: In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted. Conclusion: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.
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Affiliation(s)
- Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Jun Kinoshita
- Department of Gastroenterologic Surgery, Kanazawa University, Department of Gastroenterologic Surgery, Kanazawa University, Ishikawa, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
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Lin YF, Lai SK, Liu QY, Liao BH, Huang J, Du L, Wang KJ, Li H. Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta-analysis. Kaohsiung J Med Sci 2017; 33:107-115. [PMID: 28254112 DOI: 10.1016/j.kjms.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/14/2016] [Accepted: 11/07/2016] [Indexed: 02/05/2023] Open
Abstract
As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = -8.52, 95% confidence interval (CI) = -12.60 to -4.43, p < 0.0001] and length of hospital stay (MD = -0.96, 95% CI = -1.80 to -0.11, p = 0.03) were significantly shorter in the barbed group. Results of continence rate varied according to different studies. Subgroup analysis by type of MIRP suggested that patients who underwent barbed suture during robot-assisted surgeries had a shorter hospital stay (MD = -1.13, 95% CI = -1.82 to -0.45, p = 0.001). During the laparoscopic surgery, patients in the barbed suture group had fewer postoperative complications [odds ratio = 0.29, 95% CI = 0.08-0.98, p = 0.05). However, more evidence is needed to validate this state-of-the-art technology.
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Affiliation(s)
- Yi-Fei Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Si-Ke Lai
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qin-Yu Liu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bang-Hua Liao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Huang
- West China Hospital, Sichuan University, Chengdu, China.
| | - Liang Du
- West China Hospital, Sichuan University, Chengdu, China
| | - Kun-Jie Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- West China School of Medicine, Sichuan University, Chengdu, China; Department of Urology, West China Hospital, Sichuan University, Chengdu, China; West China Hospital, Sichuan University, Chengdu, China
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17
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Takacs JD, Singh A, Case JB, Mayhew PD, Giuffrida MA, Caceres AV, Fox-Alvarez WA, Runge JJ. Total laparoscopic gastropexy using 1 simple continuous barbed suture line in 63 dogs. Vet Surg 2016; 46:233-241. [DOI: 10.1111/vsu.12601] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/26/2016] [Accepted: 07/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Joel D. Takacs
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Ameet Singh
- Department of Clinical Studies; Companion Animal Hospital at the Ontario Veterinary College; Guelph Ontario Canada
| | - J. Brad Case
- Department of Small Animal Clinical Sciences; Small Animal Hospital at the University of Florida; Gainesville Florida
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California; Davis Davis California
| | - Michelle A. Giuffrida
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Ana V. Caceres
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
| | - W. Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences; Small Animal Hospital at the University of Florida; Gainesville Florida
| | - Jeffrey J. Runge
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
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18
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Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Perera M, Divakaran P, Roberts MJ, Chung E. Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model. J Mech Behav Biomed Mater 2016; 65:408-414. [PMID: 27643677 DOI: 10.1016/j.jmbbm.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Vesicourethal anastomosis (VUA) during radical prostatectomy can be achieved using various suture plication techniques. Traditionally, an indwelling urinary catheter remains in-situ to facilitate the healing process of the reconstructed VUA. Compromise or rupture of this anastomosis may lead to acute urinary leak and subsequent urinoma or stricture formation. This ex-vivo porcine model aims to evaluate VUA tensile strength using different suture techniques and catheter types. METHODS Male porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied until failure of the catheter balloon or the model VUA. Model failure was defined as either 'VUA rupture', 'Catheter passage through VUA' or 'catheter failure'. RESULTS Twenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with oval-balloon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). CONCLUSIONS During prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.
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Affiliation(s)
- Marlon Perera
- School of Medicine, University of Queensland, Brisbane, Queensland 4000, Australia; Department of Urology, Mackay Base Hospital, Mackay, Queensland 4840, Australia; Department of Surgery, Austin Health, University of Melbourne, Victoria 3000, Australia.
| | - Pranav Divakaran
- School of Medicine, University of Queensland, Brisbane, Queensland 4000, Australia; Department of Urology, Mackay Base Hospital, Mackay, Queensland 4840, Australia
| | - Matthew J Roberts
- School of Medicine, University of Queensland, Brisbane, Queensland 4000, Australia; Department of Urology, Mackay Base Hospital, Mackay, Queensland 4840, Australia; The University of Queensland, Centre for Clinical Research, Brisbane, Qld 4006, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | - Eric Chung
- School of Medicine, University of Queensland, Brisbane, Queensland 4000, Australia; Department of Urology, Mackay Base Hospital, Mackay, Queensland 4840, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
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20
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Albanese V, Hanson RR, McMaster MA, Koehler JW, Caldwell FJ. Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses. Vet Surg 2016; 45:824-30. [DOI: 10.1111/vsu.12520] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Valeria Albanese
- Department of Clinical Sciences; JT Vaughan Large Animal Teaching Hospital; Auburn Alabama
| | - R. Reid Hanson
- Department of Clinical Sciences; JT Vaughan Large Animal Teaching Hospital; Auburn Alabama
| | - Mattie A. McMaster
- Department of Clinical Sciences; JT Vaughan Large Animal Teaching Hospital; Auburn Alabama
| | - Jennifer W. Koehler
- Department of Pathobiology, College of Veterinary Medicine; Auburn University; Auburn Alabama
| | - Fred J. Caldwell
- Department of Clinical Sciences; JT Vaughan Large Animal Teaching Hospital; Auburn Alabama
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21
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Successful Outcomes in Robot-Assisted Laparoscopic Pyeloplasty Using a Unidirectional Barbed Suture. J Endourol 2016; 30:660-4. [DOI: 10.1089/end.2016.0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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The Single-Knot Running Vesicourethral Anastomosis after Minimally Invasive Prostatectomy: Review of the Technique and Its Modifications, Tips, and Pitfalls. Prostate Cancer 2016; 2016:1481727. [PMID: 27340567 PMCID: PMC4906212 DOI: 10.1155/2016/1481727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/12/2016] [Indexed: 12/27/2022] Open
Abstract
The vesicourethral anastomosis represents a step of major difficulty at the end of minimally invasive radical prostatectomy. Over 10 years ago, we have devised the single-knot running vesicourethral anastomosis, which has been widely adopted in urologic departments worldwide. Aim of the current paper is to review the technique, its adaptability in complex situations, its complications, and possible modifications, including the use of barbed sutures.
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Gratzke C, Dovey Z, Novara G, Geurts N, De Groote R, Schatteman P, de Naeyer G, Gandaglia G, Mottrie A. Early Catheter Removal after Robot-assisted Radical Prostatectomy: Surgical Technique and Outcomes for the Aalst Technique (ECaRemA Study). Eur Urol 2016; 69:917-23. [DOI: 10.1016/j.eururo.2015.09.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 11/24/2022]
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24
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Dennis C, Sethu S, Nayak S, Mohan L, Morsi YY, Manivasagam G. Suture materials - Current and emerging trends. J Biomed Mater Res A 2016; 104:1544-59. [DOI: 10.1002/jbm.a.35683] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/07/2016] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Christopher Dennis
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation; Bangalore Karnataka 560099 India
| | - Sunita Nayak
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
- School of Bio Sciences and Technology, VIT University; Vellore Tamil Nadu 632014 India
| | - Loganathan Mohan
- Surface Engineering Division; CSIR - National Aerospace Laboratories; Bangalore Karnataka 560017 India
| | - Yosry Yos Morsi
- Biomechanical and Tissue Engineering Labs, Faculty of Science, Engineering and Technology, Swinburne University of Technology; Australia
| | - Geetha Manivasagam
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
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25
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Fernandez LC, Toriz A, Hernandez J, Sanchez N, Linares E, Zenteno M, Cuendis A, Olivares J, Guerrero G, Cervantes CF. Knotless choledochorraphy with barbed suture, safe and feasible. Surg Endosc 2015; 30:3630-5. [PMID: 26541731 DOI: 10.1007/s00464-015-4620-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE). INTRODUCTION LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses. METHODS Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded. RESULTS Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death. CONCLUSION The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.
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Affiliation(s)
- Luis C Fernandez
- Hospital General Zona Norte, Puebla, Mexico. .,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico.
| | - Augusto Toriz
- Hospital General Zona Norte, Puebla, Mexico.,Hospital General ISSSTE, Puebla, Mexico
| | | | | | | | | | - Adolfo Cuendis
- Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico
| | | | | | - Cesar F Cervantes
- Hospital General ISSSTE, Puebla, Mexico.,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico
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Management of Challenging Urethro-ileal Anastomosis During Robotic Assisted Radical Cystectomy with Intracorporeal Neobladder Formation. Eur Urol 2015; 69:704-709. [PMID: 26463317 DOI: 10.1016/j.eururo.2015.09.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Robotic assisted radical cystectomy (RARC) is increasingly being adopted, but intracorporeal neobladder formation remains a challenging procedure limited to selected centers. Common challenges with intracorporeal neobladder formation relate to fashioning a tension-free urethro-ileal anastomosis. In this paper, we describe a series of maneuvers to overcome these challenges that we believe will be of great utility to surgeons performing intracorporeal neobladder. OBJECTIVE To describe maneuvers to overcome challenges during intracorporeal urethro-ileal anastomosis formation and to report postoperative outcomes for patients in whom these maneuvers were used. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of medical records of patients who underwent RARC with intracorporeal neobladder performed by one surgeon (G.-P.H.) at our tertiary center from January 2012 to February 2015 in which at least one additional maneuver was required beyond preservation of urethral length, removal of the sigmoid colon from the pelvis, and careful ileal loop selection. The primary end point was 90-d complications. Follow-up ranged from 6 to 36 mo, and 16 patients had at least 1-yr follow-up. SURGICAL PROCEDURE RARC with intracorporeal neobladder formation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Clinical and operative data collected from a prospectively maintained, institutional review board-approved database. Maneuvers used during intracorporeal urethro-ileal anastomosis were recorded. Descriptive statistics were used to evaluate postoperative outcomes. RESULTS AND LIMITATIONS Nineteen patients met the inclusion criteria. Mean operative time was 486 min (standard deviation: 112 min) with median hospitalization of 7 d (interquartile range: 7-9 d). Seven patients (36.8%) experienced a complication, with one (5.3%) major complication thought to be unrelated to surgery. No open conversions were required. There was no 90-d mortality. CONCLUSIONS Our stepwise approach can help overcome challenges of urethro-ileal anastomosis during intracorporeal neobladder formation. PATIENT SUMMARY When performing intracorporeal neobladder formation, challenges are often encountered in fashioning the urethro-ileal anastomosis. We describe a series of maneuvers that, when used in a stepwise manner, help overcome these challenges.
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Ma LL, Ye JF, Tang WH. Knotless laparoscopic radical prostatectomy: a preliminary experience. Chin Med J (Engl) 2015; 128:409-12. [PMID: 25635442 PMCID: PMC4837877 DOI: 10.4103/0366-6999.150120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | | | - Wen-Hao Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
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Desai D, Lah K, Chabert C, Gianduzzo T. Barbed polyglyconate vs monocryl suture in vesico-urethral anastomosis during robot-assisted radical prostatectomy. World J Clin Urol 2015; 4:92-96. [DOI: 10.5410/wjcu.v4.i2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/21/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare outcomes using barbed polyglyconate (V-Loc 180) vs monofilament monocryl suture in forming vesico-urethral anastomosis (VUA) during robot assisted radical prostatectomy.
METHODS: Review of prospectively collected robot assisted radical prostatectomy data between July 2011 and September 2012. VUA technique: VUA was performed using 2 cm × 15 cm 2/0 V-Loc 180 continuous sutures or 3/0 monofilament monocryl sutures. Anastomotic integrity was tested intra-operatively with a water leak test. All patients had a post-operative cystogram at day 7 to 10.
RESULTS: There were 189 patients in the study with 113 in the V-Loc group and 76 in the monocryl group. Demographics were similar for both groups P > 0.05). The median operative time for V-Loc group was 130 min and monocryl group was 145 min, which was statistically significant (P < 0.001). The median blood loss for both groups was 200 mL with no significant difference (P = 0.260). The pathology results of the 2 groups were similar (P = 0.537). Four patients in the V-Loc group and two patients in the monocryl group had radiological urinary leak. This was not statistically significant (P = 1.00) and all patients improved with conservative management. The continence rates were comparable for both groups.
CONCLUSION: V-Loc suture significantly reduced operative time facilitating ease of VUA formation. Overall functional outcome and urinary morbidity were not significantly different from the monofilament group.
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Li H, Liu C, Zhang H, Xu W, Liu J, Chen Y, Li T, Li B, Wu Z, Xia T. The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety. PLoS One 2015; 10:e0131167. [PMID: 26135310 PMCID: PMC4489906 DOI: 10.1371/journal.pone.0131167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/31/2015] [Indexed: 12/13/2022] Open
Abstract
Background Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial. Aims The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP. Methods We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC). Results Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45–-4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52–-0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6–12 months after surgery. Conclusions Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.
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Affiliation(s)
- Huixin Li
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- * E-mail:
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Haibin Zhang
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Wenfeng Xu
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Jianhua Liu
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Yong Chen
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Tangxuan Li
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Bin Li
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Zhenquan Wu
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
| | - Taolin Xia
- Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China
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Bai Y, Pu C, Yuan H, Tang Y, Wang X, Li J, Wei Q, Han P. Assessing the Impact of Barbed Suture on Vesicourethral Anastomosis During Minimally Invasive Radical Prostatectomy: A Systematic Review and Meta-analysis. Urology 2015; 85:1368-75. [DOI: 10.1016/j.urology.2015.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/20/2015] [Accepted: 02/27/2015] [Indexed: 10/25/2022]
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Albisinni S, Limani K, Hawaux E, Peltier A, Van Velthoven R. Evaluation of the single-knot running vesicourethral anastomosis 10 years after its introduction: results from an international survey. J Laparoendosc Adv Surg Tech A 2015; 24:640-6. [PMID: 25192249 DOI: 10.1089/lap.2014.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the acceptance of the single-knot running vesicourethral anastomosis in a worldwide survey, 10 years after its introduction. MATERIALS AND METHODS A survey composed of 13 multiple-choice questions was launched on the Internet. Urologists involved in minimally invasive surgery were invited to participate. Questions explored professional characteristics of the respondents, experience with the single-knot running vesicourethral anastomosis, complications (including technical, early, and late complications), and a general opinion on the technique. RESULTS The 391 urologists who participated in the survey worked in academic, private, and community settings. Live surgeries appear to have been the most important tool to teach the technique. The global experience gained with this technique is vast: in the last 10 years we calculated over 120,000 anastomoses were performed by our cohort of respondents. Overall, technical, early (mainly uncomplicated early leakage), and late complications (mainly anastomotic stricture) were observed in <2% of cases by the majority of surgeons in the survey. Most urologists in the survey seem to accept the technique as a commonly used procedure in urologic surgery. CONCLUSIONS Today, in 2014, the single-knot running anastomosis technique appears to have been well accepted by the urologic community. However, research should continue always in order to explore and invent better surgical solutions for our patients.
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Affiliation(s)
- Simone Albisinni
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles , Brussels, Belgium
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Toussi A, Turner RM, Corcoran AT, Jackman SV. Recurrent Foley catheter puncture and displacement: a complication of the use of barbed polyglyconate suture to facilitate vesicourethral anastomosis during robot-assisted radical prostatectomy. J Robot Surg 2014. [DOI: 10.1007/s11701-014-0450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg 2014; 12:1385-9. [DOI: 10.1016/j.ijsu.2014.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/17/2014] [Accepted: 10/25/2014] [Indexed: 11/18/2022]
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Samavedi S, Abdul-Muhsin H, Pigilam S, Sivaraman A, Patel VR. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis. Indian J Urol 2014; 30:418-22. [PMID: 25378824 PMCID: PMC4220382 DOI: 10.4103/0970-1591.142070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Vesico-urethral anastomosis (VUA) is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP) in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.
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Affiliation(s)
- Srinivas Samavedi
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | - Haidar Abdul-Muhsin
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | - Suneel Pigilam
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | | | - Vipul R Patel
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
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Takeda T, Miyajima A, Kaneko G, Hasegawa M, Kikuchi E, Oya M. Unidirectional barbed suture for vesicourethral anastomosis during laparoscopic radical prostatectomy. Asian J Endosc Surg 2014; 7:241-5. [PMID: 24861205 DOI: 10.1111/ases.12115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/17/2014] [Accepted: 04/14/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We investigated the impact of unidirectional barbed suture (UBS) for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy. METHODS The polyglyconate UBS V-Loc 180 was used for VUA during laparoscopic radical prostatectomy in 30 consecutive patients who were diagnosed with organ-confined prostate cancer between January and October 2012. The operative and postoperative parameters were then compared with those of 30 consecutive patients who had previously undergone the same procedure but with the monofilament poliglecaprone suture Monocryl. All procedures were performed by the same experienced surgeon. RESULTS VUA time was significantly shorter in the V-Loc group (13.2 ± 2.3 min) than in the Monocryl group (19.1 ± 3.3 min) (P < 0.001). The V-Loc group required significantly more stitches than the Monocryl group (11.4 ± 1.3 vs 10.6 ± 1.6 stitches; P = 0.031). The percentage of patients who required no more than one pad per day at 3 months postoperatively was significantly higher in the V-Loc group (63.3%) than in the Monocryl group (23.3%) (P = 0.020). No significant differences in other perioperative parameters were observed between the two groups. CONCLUSION Using UBS prevents suture slippage and enables tieless anastomosis. VUA using a UBS may relieve surgeon stress because a rapid and secure anastomosis is achievable.
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Affiliation(s)
- Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hamada A, Razdan S, Etafy MH, Fagin R, Razdan S. Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique. J Endourol 2014; 28:930-8. [DOI: 10.1089/end.2013.0794] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alaa Hamada
- Department of Urology, Jackson South Hospital, Miami, Florida
| | | | | | | | - Sanjay Razdan
- Department of Urology, Herbert Wertheim Florida International University College of Medicine, Jackson South Hospital, Miami, Florida
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Rubin JP, Hunstad JP, Polynice A, Gusenoff JA, Schoeller T, Dunn R, Walgenbach KJ, Hansen JE. A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures. Aesthet Surg J 2014; 34:272-83. [PMID: 24421408 DOI: 10.1177/1090820x13519264] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Barbed sutures were developed to reduce operative time and improve security of wound closure. OBJECTIVE The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. METHOD A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. RESULTS A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. CONCLUSIONS Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- J Peter Rubin
- Dr Rubin is the chair of the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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38
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Ali A, Tewari A. Radical Surgery. Prostate Cancer 2014. [DOI: 10.1002/9781118347379.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Spah CE, Elkins AD, Wehrenberg A, Jaffe MH, Baird DK, Naughton JF, Payton ME. Evaluation of two novel self-anchoring barbed sutures in a prophylactic laparoscopic gastropexy compared with intracorporeal tied knots. Vet Surg 2013; 42:932-42. [DOI: 10.1111/j.1532-950x.2013.12043.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Chad E. Spah
- VCA Advanced Veterinary Care Center; Fishers; IN
| | - A. D. Elkins
- VCA Advanced Veterinary Care Center; Fishers; IN
| | | | | | | | | | - Mark E. Payton
- Department of Statistics, Oklahoma State University; Stillwater; OK
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Massoud W, Thanigasalam R, El Hajj A, Girard F, Théveniaud PE, Chatellier G, Baumert H. Does the use of a barbed polyglyconate absorbable suture have an impact on urethral anastomosis time, urethral stenosis rates, and cost effectiveness during robot-assisted radical prostatectomy? Urology 2013; 82:90-4. [PMID: 23806395 DOI: 10.1016/j.urology.2013.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 01/18/2013] [Accepted: 02/01/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the use of a single needle driver with the V-Loc (Covidien, Dublin, Ireland) running suture and compare this with the use of 2 needle drivers with polyglactin interrupted sutures (IS) in dividing the dorsal venous complex (DVC) and forming the urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS A prospective cohort study was performed to compare V-Loc (n = 40) with polyglactin (n = 40) sutures. Division of the dorsal venous complex and formation of the UVA during robot-assisted radical prostatectomy using V-Loc or polyglactin sutures were studied. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS V-Loc sutures were associated with a statistically significant reduction in mean dorsal vein suture time (3.15 minutes V-Loc vs 3.75 minutes IS, P = .02) and UVA anastomosis time (8.5 minutes V-Loc vs 11.5 minutes IS, P = .001). No significant difference was noted between operative time (121 minutes V-Loc vs 130 minutes IS, P = .199), delayed healing rates (5% V-Loc vs 7.5% IS, P = .238), continence rate at 12 months (97.5% V-Loc vs 95% IS, P = .368), and urethral stenosis rates (2.5% V-Loc vs 2.5% IS, P = .347) in both groups. CONCLUSION The use of a V-Loc running suture with a single needle driver is a feasible, reproducible, and economic technique with no significant difference in continence rates and urethral stenosis rates, compared with the use of a traditional interrupted suture.
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Affiliation(s)
- Walid Massoud
- Department of Urology, Hôpital Saint Joseph, Paris, France
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41
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Milone M, Di Minno MND, Galloro G, Maietta P, Bianco P, Milone F, Musella M. Safety and Efficacy of Barbed Suture for Gastrointestinal Suture: A Prospective and Randomized Study on Obese Patients Undergoing Gastric Bypass. J Laparoendosc Adv Surg Tech A 2013; 23:756-9. [PMID: 23859743 DOI: 10.1089/lap.2013.0030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Milone
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
| | | | - Giuseppe Galloro
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
| | - Paolo Bianco
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Science, University of Naples “Federico II,” Naples, Italy
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Matarasso A, Rosen AD. New and emerging uses of barbed suture technology in plastic surgery. Aesthet Surg J 2013; 33:90S-5S. [PMID: 24084885 DOI: 10.1177/1090820x13500048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Barbed sutures first received US Food and Drug Administration approval for soft tissue approximation in 2005 and early adopters readily embraced this device to develop new techniques. It has become apparent that the advantages are more than just "skin deep." Superficial and deep fascia, cartilage, tendon, joint capsule, and fibrous periprosthetic capsules can also be manipulated. Barbed sutures have revolutionized our approach to facial rejuvenation and body contouring by enhancing our ability to quilt and powerfully lift tissue. The elimination of surgical drains and shorter surgical times has made this a true boon for plastic surgeons as well as many other surgical specialists. This article summarizes some of the current and evolving applications of this exciting new tool.
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Affiliation(s)
| | - Allen D. Rosen
- Dr Rosen is an Assistant Clinical Professor in the Department of Plastic Surgery, University of Medicine and Dentistry of New Jersey, Montclair
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De Blasi V, Facy O, Goergen M, Poulain V, De Magistris L, Azagra JS. Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg 2013; 23:60-3. [PMID: 22968833 DOI: 10.1007/s11695-012-0763-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass is one of the main bariatric procedures that require safe and reproducible anastomosis. The objective of this study is to compare the risk of leaks and stenosis of a mechanical gastric pouch jejunal anastomosis between the usual interrupted sutures and a continuous barbed suture for gastrojejunotomy, in order to reduce procedure time and costs. METHODS A comparative trial of 100 consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass was performed between October 2010 and July 2011. The population was divided into two groups of 50 consecutive patients. In the first group, gastrojejunotomy was sutured with resorbable interrupted sutures and the second with continuous barbed suture. Diabetes, body mass index and the American Society of Anaesthesiology score were compared. The time required for suturing and the incidence of anastomotic leaks and stricture were also compared after 6 months. RESULTS No fistulas or anastomotic stenoses had occurred at post-operative month 6 in either group. Gastrojejunotomy suture time was significantly shorter in the barbed suture group (11 versus 8.22 min; p < 0.01). Total costs of material to complete the reconstruction were significantly lower in the barbed suture group (€26.69 versus €18.33; p < 0.001). CONCLUSIONS The use of barbed suture is as safe as usual sutures and allows easier and faster suture in the closure of gastrojejunotomy. This suture could be incorporated in the standard laparoscopic Roux-en-Y gastric bypass technique.
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Affiliation(s)
- Vito De Blasi
- Multidisciplinary Unit of Digestive and Endocrine Diseases, University Hospital Centre of Luxembourg, Luxembourg, Luxembourg.
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Fiori C, Amparore D, Checcucci E, Aimar R, Scarpa RM, Porpiglia F. [Suture materials in urology]. Urologia 2013; 80:179-87. [PMID: 24526594 DOI: 10.5301/ru.2013.11503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 11/20/2022]
Abstract
Since ancient times, sutures have been a fundamental part of the surgeon's practice. Beside the vegetable and animal origin materials, in the last decades different refined synthetic materials have been introduced in the clinical practice. More recently, different devices, such as staplers and tissue sealers have been developed. Thus, more than ever, urologists are faced with a multitude of suture materials, and research of safe, effective materials and devices seems to be continuously growing. The introduction and widespread diffusion of laparoscopic and robotic surgery has further boosted this research. Given there is no single material that is ideal for all situations, the surgeon must choose the best material for each particular case.
The aim of this non-systematic review is to summarize the more innovative suture materials and devices and to describe the different surgical methods to utilize them both in general and in urologic surgery.
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Affiliation(s)
- Cristian Fiori
- AOU San Luigi Hospital, University of Turin, Orbassano, Torino - Italy
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Matsuhashi N, Takahashi T, Nonaka K, Tanahashi T, Imai H, Sasaki Y, Tanaka Y, Okumura N, Yamaguchi K, Osada S, Yoshida K. Laparoscopic technique and safety experience with barbed suture closure for pelvic cavity after abdominoperineal resection. World J Surg Oncol 2013; 11:115. [PMID: 23705750 PMCID: PMC3685598 DOI: 10.1186/1477-7819-11-115] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between April 2005 and December 2012, we performed laparoscopic colorectal resection with regional lymph node dissection on 273 cases of colorectal cancer patients. However, Laparoscopic rectal cancer surgery requires a high degree of skill. Any surgeon who is going to embark on these difficult resections should have at a minimum laparoscopic suturing skills in order to be able to close the peritoneal defect. METHODS In laparoscopic surgery for rectal cancer, the intracorporeal suture technique required to close the pelvic cavity is very difficult. Barbed sutures have recently been proposed to facilitate laparoscopic suturing. Two patients with rectal cancer who underwent laparoscopic abdominoperineal resection (APR) with intracorporeal closure of the pelvic cavity from September to October 2012 were enrolled in this study. RESULTS We present our initial experience of two consecutive cases of intracorporeal closure of the pelvic cavity by totally laparoscopic APR. After clinical follow-up, the two patients have no complaints and have shown no signs of recurrence. CONCLUSIONS We hypothesized that barbed sutures could potentially improve the efficiency of intracorporeal closure of the pelvic cavity after laparoscopic APR. Further, we expect that use of the V-Loc™ will reduce intra-operative stress on the endoscopic surgeon.
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Affiliation(s)
- Nobuhisa Matsuhashi
- Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan
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Facy O, De Blasi V, Goergen M, Arru L, De Magistris L, Azagra JS. Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc 2013; 27:3841-5. [PMID: 23670743 DOI: 10.1007/s00464-013-2992-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/18/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Intestinal anastomosis is a complex procedure during laparoscopy, mainly due to the difficulties knotting the sutures. Unidirectional barbed sutures have been proposed to simplify wall and mesentery closure, but the results for intestinal anastomosis are not clear. This study aimed to establish the feasibility and the safety of laparoscopic intestinal anastomosis using barbed suture. METHODS Between June 2011 and May 2012, 15-cm-long unidirectional absorbable barbed sutures (V-Loc; Covidien, Mansfield, MA, USA) were used for all laparoscopic intestinal anastomoses: one suture for closure of intestinal openings after mechanical anastomoses and two sutures for hand-sewn anastomoses. RESULTS Over a 1-year period, 201 consecutive patients required 220 laparoscopic anastomoses for gastrojejunostomy (n = 177; 172 during Roux-en-Y gastric bypass and 5 after gastrectomy), ileocolostomy (n = 15), colocolostomy (n = 1), esophagojejunostomy (n = 5), and jejunojejunostomy (n = 22; 4 after small bowel resection and 18 during gastric bypass or gastrectomy). Senior and training surgeons performed 209 closures of intestinal openings and 11 hand-sewn anastomoses. There was no conversion to usual sutures. One fistula occurred in an esophagojejunostomy and was managed conservatively. One self-limited anastomotic bleeding occurred, and no anastomotic stenosis occurred during 6 months of follow-up evaluation. CONCLUSIONS The use of knotless barbed suture for laparoscopic intestinal anastomosis is safe and reproducible.
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Affiliation(s)
- Olivier Facy
- Department of Digestive Surgery, University Hospital of Luxembourg, Luxembourg, Luxembourg,
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Nemecek E, Negrin L, Beran C, Nemecek R, Hollinsky C. The application of the V-Loc closure device for gastrointestinal sutures: a preliminary study. Surg Endosc 2013; 27:3830-4. [PMID: 23644839 DOI: 10.1007/s00464-013-2982-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/16/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Leakage is one of the major complications in gastrointestinal surgery. This preliminary study compared a new barbed absorbable thread for gastrointestinal sutures with monofil suture material in a cadaver model. METHODS In this study, mechanical experiments were performed in 20 recently deceased individuals. Incisions were made in the small intestine, colon, and stomach, and then sutures were created with the V-Loc closure device and monofil suture material. Intestinal bursting pressure was measured by inserting a balloon and slowly filling it with air until there was a dehiscence, or wall or suture rupture. RESULTS The bursting pressures differed significantly between the two sutures in the small intestine, showing the advantage of the V-Loc closure device, which had a mean bursting pressure of 116.2 mmHg compared with 110 mmHg for the monofil suture (p = 0.003). The mean bursting pressure did not differ significantly between the two sutures in the colon and the stomach. The mean bursting pressures for the V-Loc closure device were 141.3 mmHg (stomach) and 137.2 mmHg (colon) compared with the monofil suture material bursting pressures of 133 mmHg (stomach) and 134.8 mmHg (colon). CONCLUSIONS Because the bursting strength of the sutures created with monofil suture material differs significantly from that of the V-Loc closure device, the V-Loc suture material should be used for gastrointestinal sutures. Although the two sutures did not differ significantly in the colon or the stomach, the V-Loc closure device should be used for these as well because its advantages may overrule those of the monofil suture. No knot tying is required, and the operating time can be shorter. Especially for laparoscopic surgery, the V-Loc closure device is recommended.
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Affiliation(s)
- Elena Nemecek
- Department for Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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Jeon SH, Jung S, Son HS, Kimm SY, Chung BI. The unidirectional barbed suture for renorrhaphy during laparoscopic partial nephrectomy: Stanford experience. J Laparoendosc Adv Surg Tech A 2013; 23:521-5. [PMID: 23414123 DOI: 10.1089/lap.2012.0405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Using barbed suture represents a novel technical modification in the performance of minimally invasive partial nephrectomy. Our purpose of this study was to evaluate the safety and efficacy of this suture for renorrhaphy during laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS Thirteen consecutive patients underwent LPN using V-Loc™ 180 (Covidien, Dublin, Ireland) suture, and a nonconsecutive control group of 24 patients, matched according to tumor size and R.E.N.A.L. nephrometry score, underwent LPN using absorbable polyglactin suture. All 37 patients underwent LPN performed by a single surgeon. Perioperative and postoperative indicators of morbidity, estimated blood loss, and warm ischemia time (WIT) were compared between the groups. RESULTS Baseline characteristics including age, body mass index, American Society of Anesthesiologists score, tumor size, laterality, and R.E.N.A.L nephrometry score were identical between the groups. On multivariable analysis, there were no significant differences between the two groups with regard to operative time, estimated blood loss, transfusion rates, rates of surgical complications, and length of hospital stay. However, mean WIT was significantly shorter in the V-Loc group compared with the control group (24.5±5.3 minutes versus 31.9±8.9 minutes, P=.01). CONCLUSIONS The use of V-Loc sutures for renorrhaphy during LPN is safe and feasible and, in our series, significantly reduces WIT. Further studies are needed to corroborate these findings, but these results indicate a promising development in reducing WIT during minimally invasive partial nephrectomy.
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Affiliation(s)
- Seung Hyun Jeon
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
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Unfavorable outcomes of laparoscopic pyeloplasty using barbed sutures: a multi-center experience. World J Urol 2013; 31:1441-4. [PMID: 23292256 DOI: 10.1007/s00345-012-1019-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/22/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Barbed self-retaining sutures (SRS) have been introduced as an advance in suture technology, facilitating reconstructive laparoscopic surgery. We present the experience of three centers performing laparoscopic pyeloplasty with the use of SRS. METHODS Preoperative, intraoperative and follow-up data were collected for 6 patients undergoing pyeloplasty using the Quill SRS (Angiotech, Vancouver, CAN) in three centers. Standard laparoscopic pyeloplasty technique was used and a knot-less continuous anastomosis between the spatulated ureter and the renal pelvis was created. RESULTS Knot-less uretero-pelvic anastomosis creation was feasible in all six cases. Peri-operative data were similar to standard pyeloplasty using conventional suture materials. A very high stricture recurrence rate (5/6 patients) was noted during follow-up. Further endourologic and open interventions were needed to address the recurrence of the strictures. CONCLUSIONS Knotless intracorporeal laparoscopic suturing using SRS for the reconstruction of UPJ during laparoscopic pyeloplasty is associated with high rates of stricture recurrence at least in the initial cases of each surgeon. Until further investigations elucidate the cause of treatment failure, SRS should not be recommended for upper urinary tract reconstruction.
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PETRUT BOGDAN, HOGEA MAXIMILIAM, FETICA BOGDAN, KOZAN ANDREI, FEFLEA DRAGOS, SERERMAN GABRIEL, GOEZEN ALISERDAR, RASSWEILER JENS. In-vivo assessment of barbed suturing thread with regard to tissue reaction and material absorption in a rat model. CLUJUL MEDICAL (1957) 2013; 86:371-6. [PMID: 26527981 PMCID: PMC4462465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
AIM The laparoscopic approach in urological surgery demands a high degree of skill in intracorporeal suturing and knot tying. In an effort to reduce the amount of time required to perform a suture, new materials have been developed that through selfanchorage distribute tension more evenly across the suture and also eliminate the need of knot tying. The goal of this study was to assess the in vivo tissue response to a novel material (V-Loc tm; Covidien) in comparison to established materials (Vicryl, PDS II), in the case of bladder suturing, in a rat model. METHODS The study included 48 male Wistar rats. All underwent a median abdominal incision, with a 1cm cystotomy, followed by a running suture. The suture material used was either V-Loc absorbable self anchoring thread, Vicryl threaded absorbable suture or monofilament absorbable suture. The abdominal cavity and the bladder suture were macroscopically evaluated at the rats' scheduled death at 3 and 6 weeks. The bladder wall was microscopically assessed by a pathologist, with regard to tissue reaction and suture material degradation. RESULTS All rats survived the procedure, with the abdominal scar fully healed at week 2. There were no signs of infection or lithiasis during the observation. Macroscopically, at 3 weeks, the suture material was recognizable and visible in all cases, with special mention that the V-Loc thread was considerably more rigid, retaining its shape almost entirely, and provoked more adhesion of the surrounding tissue. At 6 weeks, the suture was indistinguishable in the bladder wall in the case of monofilament absorbable material, barely visible in the case of Vicryl, while the aspect of the V-Loc suture resembled the one at 3 weeks, with the material still clearly visible in the bladder wall, shape almost entirely maintained, and surrounding tissue adherence. Microscopically, at 3 weeks and 6 weeks, all bladder walls examined had regained their structure. At 3 weeks, the monofilament absorbable suture showed intense tissue reaction, with the material already in phagocytosis; at 6 weeks, no clear evidence of leftover material was observed. At 3 weeks, the Vicryl material showed moderate tissue reaction, with phagocytosis initiated between the strands of the material; at 6 weeks, the material was almost entirely absorbed, but with a clear leftover tissue reaction. In the case of the V-Loc suture, due to the hardness of the thread, the material itself could not be cut for analysis with the bladder wall, and the examination could only involve the bladder wall and marks of the thread. Thus, the tissue reaction was minimal, as was the presence of phagocytes at the suture site. The material showed little, if any, signs of absorption after 6 weeks. CONCLUSION The materials tested all proved equally effective in suturing the bladder wall in a rat model. However, the novel barbed thread proved a consistently low in-vivo absorption rate, while maintaining its rigidity over time. More research is needed to assess the possible clinical implications of these findings.
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Affiliation(s)
- BOGDAN PETRUT
- Department of Urology, Oncological Institute Cluj Napoca, Romania,Address for correspondence:
| | - MAXIMILIAM HOGEA
- Department of Urology, Oncological Institute Cluj Napoca, Romania
| | - BOGDAN FETICA
- Department of Urology, Oncological Institute Cluj Napoca, Romania
| | - ANDREI KOZAN
- Department of Urology, Oncological Institute Cluj Napoca, Romania
| | - DRAGOS FEFLEA
- Department of Urology, Oncological Institute Cluj Napoca, Romania
| | - GABRIEL SERERMAN
- Department of Urology, Oncological Institute Cluj Napoca, Romania
| | - ALI SERDAR GOEZEN
- SLK Klinikum Heilbronn, affiliated to the University of Heidelberg, Germany
| | - JENS RASSWEILER
- SLK Klinikum Heilbronn, affiliated to the University of Heidelberg, Germany
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