A comparison of continuous and interrupted suturing in laparoscopic pyeloplasty

Comparison of continuous and interrupted suture techniques in pyeloplasty: a systematic review and meta-analysis

Pelvi-ureteric anastomosis is a critical step to ensure good outcome of pyeloplasty. Continuous suturing technique, especially for laparoscopic surgeries, may offer faster operative time while allowing water-tight anastomosis and remains an alternative to interrupted suturing technique. There has been mixed data on comparison of outcomes of continuous and interrupted suturing techniques. This systematic review and meta-analysis aim to assess the outcomes of pyeloplasty based on continuous and interrupted suturing techniques. Following protocol registration on PROSPERO (CRD42021269706), a systematic review was performed in accordance with Cochrane Collaboration. A literature search was performed in September 2021 across Medline, EMBASE, Scopus, Cochrane Library, and ClinicalTrials.gov. Records comparing pyeloplasty outcomes between continuous and interrupted suture techniques were included. Five studies were identified for inclusion (2 prospective, 3 retrospective). Three studies involved pediatric patients. Three studies exclusively assessed laparoscopic technique. Four outcomes were meta-analyzed: operative time, length of stay, complications, and pyeloplasty failure. Interrupted sutures had longer OR time (mean difference 33.14 min [95% CI 29.35-36.94], p < 0.0001) and length of stay (mean difference 1.08 days [95% CI 0.84-1.32], p < 0.0001). However, there were similar complication (OR 1.73 [95% CI 0.98-3.06], p = 0.06) and failure rates (OR 1.21 [95% CI 0.43-3.43], p = 0.71) between the two suture types. The overall risk of bias in the studies was high. While limited by the number of studies available, continuous sutures for pelvi-ureteric anastomosis appear to confer benefits of faster operative time and decreased length of stay without increasing complication rates or failures.

Barbed Versus Non-Barbed Suture for Pyeloplasty via the Minimally Invasive Approach: A Systematic Review and Meta-Analysis

Background: There is no agreed protocol on usage of proper and best suturing material in minimally invasive pyeloplasty. The aim of this meta-analysis was to summarize and analyze current evidence on suturing materials for laparoscopic pyeloplasty. Materials and Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant comparative studies on barbed suture (BS) and non-barbed suture (NBS) in minimally invasive pyeloplasty. Results: Five comparative studies met the inclusion criteria and were included in the meta-analysis. Pooling the data demonstrated a significantly shorter operative duration in patients belonging to the BS group versus the NBS group (95% confidence interval [CI] -81.63 to -10.41, P = .01), with statistically significant estimated heterogeneity among the included studies (P < .0001). Although the incidence of redo-pyeloplasty was higher in the BS group, the pooled risk ratio (RR) for the need for redo-pyeloplasty in subjects belonging to the BS group versus the NBS group was 6.00 (95% CI 0.78-46.14), demonstrating no statistically significant difference (P = .09). A total of 5 patients developed postoperative complications. The pooled RR for the occurrence of these complication showed no significant difference among the patients belonging to both the groups (95% CI 0.22-6.05, P = .88). Conclusions: Minimally invasive pyeloplasty using BS is associated with significantly shorter operative time. The incidence of postoperative complications and requirement of redo-pyeloplasty showed no significant difference among both the treatment groups. Further randomized controlled trials need to be conducted before any definite conclusions are drawn.

Comparative analysis of suturing technique in pediatric pyeloplasty on surgical outcomes

PURPOSE

Pyeloplasty for ureteropelvic junction obstruction is the gold standard for surgical repair. There are currently no reports outlining optimal suturing technique. This paper compares the effect of suturing technique in dismembered pediatric pyeloplasty (open and laparoscopic) on post-operative outcomes.

METHODS

A non-concurrent cohort study assessed different suturing techniques in both open and laparoscopic dismembered pyeloplasty performed two senior urologists at a tertiary referral pediatric center. Cases were stratified according to different suturing techniques for ureteropelvic anastomosis and subgroup analysis was performed according to open or laparoscopic approach.

RESULTS

A total of 185 renal units were evaluated. The overall comparative analysis of different anastomotic suturing techniques and clustered analysis according to open and laparoscopic approach showed no significant differences on post-operative complication rate, leakage, stenosis, redo-pyeloplasties, operative time and hospital stay. There was a significant difference between suturing techniques on stent duration, age and weight of the patient. There was no effect of suture type or size on post-operative complication rate, leakage, UPJ stenosis and redo pyeloplasty rates, however, sample sizes were small.

CONCLUSION

Suturing technique has no significant effect on the surgical outcomes assessed regardless of open or laparoscopic technique.

A comparative study between continuous and interrupted sutures in open pyeloplasty

BACKGROUND

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Different surgical techniques that influenced internal hernia prevalence rate after laparoscopic roux-en-Y gastric bypass: a retrospective analysis of 331 cases

BACKGROUND

Internal hernia (IH) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB), and closure of mesenteric defect has been recommended to reduce this complication. But what kind of material about suture and how to close the mesenteric defects were still controversial. The main aim of this study was to compare the incidence rate of internal hernia after LRYGB between patients with different surgical techniques.

METHOD

Three hundred and thirty-one patients underwent LRYGB between June 2004 and December 2017 in one single institute were retrospective analysed. The IH rate was evaluated according to different surgical methods and surgical materials before and 12 months after LRYGB.

RESULTS

All the cases were subdivided into three groups based on the suturing method, Roux limb position, and Suture material. The mean follow up time was 36 ± 12 months, and the total incident rate of IH was 1.8% (n = 6). In the six IH cases, the duration of IH occurred time ranged from 1 month to 36 months postoperatively, and for the IH sites, one for intestinal defect, three for transverse mesocolon defect and two Peterson defect respectively. There was a significant difference about IH rate between interrupted suture and running suture groups (p = 0.011), and there were no significant differences between the other two groups.

CONCLUSION

Compare with interrupted suture, running suture may prevent IH after LRYGB. Patient's gender, age, body mass index(BMI), glycometabolism condition, and Roux limb position and suture material had no effects on the IH prevalence after LRYGB.

Retrospective comparison of outcomes of laparoscopic pyeloplasty using barbed suture versus nonbarbed suture: A single-center experience

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.

Robotic surgery in pediatric urology: Current status

Robot-assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3-D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

Laparoscopic single-incision triangulated umbilical surgery (SITUS) pyeloplasty: a description of the first 32 cases

INTRODUCTION AND OBJECTIVES

Transumbilical laparoendoscopic (LESS) procedures reduce access trauma. Laparoendocopic single-incision triangulated umbilical surgery (SITUS) utilizes straight instruments in a triangulated fashion, via three trocars placed through a single umbilical incision.

METHODS

Thirty-two consecutive patients underwent an SITUS pyeloplasty. Access is performed by incision of the umbilical fold by 3/4 of its circumference, a 5-mm camera port, and consequently, cranial and caudal 3 or 5 mm working trocars are placed at a distance of 3-6 cm, thus allowing triangulation. SITUS laparoscopy utilizes the standard straight instruments with a length of 43 cm.

RESULTS

All procedures were successfully performed and no conversion to open, or conventional laparoscopic approach was deemed necessary. Thirty patients underwent a dismembered and two a Fenger pyeloplasty. A crossing vessel was identified in 68.75% of the cases. The median laparoscopic and suturing times were 130 and 30 min, respectively; median blood loss was 50 ml. The median duration of hospitalization was 4 days. The visual analogue scores (VAS) reported were 1 on the first and 0 on the third postoperative day. The indwelling double-J or mono-J stents were removed after a median time of 5 weeks and 4 days, respectively. The overall success rate was 96.8%.

CONCLUSIONS

The SITUS technique for pyeloplasty is an attractive alternative to conventional laparoscopy and a viable competitor to LESS surgery. It combines the common principles of traditional laparoscopy, such as conventional instrumentation and triangulation, with the benefits of single-port surgery.

Laparoscopic Suturing as a Barrier to Broader Adoption of Laparoscopic Surgery

BACKGROUND

Laparoscopic surgery is increasingly replacing the open procedure because of its many patient-related benefits that are well aligned with policies and programs that seek to optimize health system performance. However, widespread adoption of laparoscopic surgery has been slow, in part, because of the complexity of laparoscopic suturing. The objective of this study was to review the clinical and economic impacts of laparoscopic suturing in key procedures and to assess its role as a barrier to the broader adoption of laparoscopic surgery.

DATABASE

A medical literature search of MEDLINE, EMBASE, and BIOSIS from January 2010 through June 2016 identified 47 relevant articles.

CONCLUSION

Laparoscopic suturing and intracorporeal knot tying may result in extended surgical time, complications, and surgeon errors, while improving patient quality of life through improved cosmesis, diet toleration, and better bowel movements. Despite advancement in surgical techniques and the availability of newer surgical tools, the complexity of laparoscopic suturing continues to be a barrier to greater adoption of MIS. The results of the study underscore the need for development of proficiency in laparoscopic suturing, which may help improve patient outcomes and reduce healthcare costs.

Interrupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy: protocol for a systematic review and meta-analysis

INTRODUCTION

Radical prostatectomy is the mainstay of treatment for prostate cancer. The vesicourethral anastomosis is a critical step, which most likely impacts urinary continence and urethral stenosis. To date, it still remains unclear whether interrupted and continuous suturing for the anastomosis have different outcomes. Therefore, the aim of this systematic review and meta-analysis is to compare different suture techniques for vesicourethral anastomosis in terms of surgical and functional parameters.

METHODS AND ANALYSIS

A comprehensive literature search will be conducted covering MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. Studies comparing interrupted versus continuous suturing will be included in the analyses. No language restrictions will be applied. Screening, data extraction, statistical analysis and reporting will be done in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment will be performed with the help of the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale for assessing quality of non-randomised studies. The quality of evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation. The primary outcome will be the time until removal of the urinary catheter. Secondary outcomes include rate of extravasation, length of hospital stay, time needed to perform the anastomosis, continence level at defined postoperative intervals and development of urethral strictures. Quantitative analysis will be calculated if meaningful.

ETHICS AND DISSEMINATION

In order to meet the highest ethical and methodological standards. we followed the PRISMA Protocol 2015 checklist. Each item was answered appropriately. For systematic reviews the ethical issues are strictly methodological as only data that were published earlier will be used. The full manuscript will be submitted to a peer-reviewed journal. Furthermore, the results will be presented on national and international congresses.

TRIAL REGISTRATION NUMBER

International prospective register of systematic reviews PROSPERO CRD42017076126.

Slip-Knot-Loop Suture for Continuous Suturing in Laparoscopy

AIMS

One of the challenges of laparoscopic surgery is the time required to perform intracorporeal knots. This can result in considerably longer operating times when compared with the open approach. An example of this is pediatric laparoscopic pyeloplasty, where extensive laparoscopic suturing is required. To reduce the time suturing, the authors developed a new knotting technique for laparoscopic suturing.

MATERIALS AND METHODS

The authors modified a neurosurgical knot technique to speed up intricate continuous suturing, and a simple slip-knot-loop suture was created. Twenty continuous sutures were performed with five "bites" of tissue each. Ten were performed with a conventional intracorporeal knot to anchor the suture (Group 1), and 10 were performed using the slip-knot-looped suture to anchor (Group 2). This new knotting technique was used to perform five bowel anastomoses on pig intestine and tested for leaks by distending them with saline for 5 minutes.

RESULTS

The mean time to perform the suture for Group 1 was 300 seconds, and the mean time for Group 2 was 236 seconds. Unpaired two-tailed Student's t test comparing the means was significant (P < .001). No leaks occurred in any of the five anastomoses.

CONCLUSIONS

This new slip-knot-loop technique modified for pyeloplasty was easy to use, was quicker than conventional knot tying, and produced safe knots and leak-free anastomoses. This knot is transferable to any laparoscopic procedure where continuous suturing is to be used.