1390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP
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Résumé
You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease II1 Apr 20121390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP Kevin Zorn, Quoc-Dien Trinh, Dan Liberman, and Assaad ElHakim Kevin ZornKevin Zorn Montreal, Canada More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Montreal, Canada More articles by this author , Dan LibermanDan Liberman Montreal, Canada More articles by this author , and Assaad ElHakimAssaad ElHakim Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic vesicourethral anastomosis (VUA) using the Van Velthoven technique has significantly improved urinary reconstruction during RARP. Recent series suggest off-label use of barbed polyglyconate suture may facilitate VUA, however the long-term risk for stricture formation and impact on urinary continence is unknown. Compared to standard monofilament posterior reconstruction (PR) and VUA technique, we sought to evaluate the effectiveness of VLOC for urinary reconstruction with minimum 1 year followup. METHODS A prospective,randomized study was conducted in 120 consecutive RARP cases by a single-surgeon. Assurance of watertight closure was ensured with 300mL intraoperatively. Time to complete the suture setup, anastomosis time and need to adjust suture tension were recorded. Suture related complications, validated-questionnaire continence and a cost analysis were also analyzed. RESULTS Compared to our conventional reconstruction technique, there was a significant reduction in mean reconstruction time (14.1 vs 22.2 min; p < 0.01). Need to readjust suture tension or place additional LapraTy clips to establish a watertight closure was observed in 13 (22%) vs 5 (8%) of cases (p = 0.05). A cost reduction was also noted favouring the interlocked VLOC technique (48.05$ vs 70.25$CAN). Time to foley removal was comparable between groups(4.1 vs 4.2 days, p = 0.87). Need for catheter replacement was similar between groups (both 5%). With a mean followup of 18.2 months, no delayed clinical anastomotic leaks or bladder neck contractures were observed in either group. Padfree continence outcomes at 1 (64% vs 69%, p = 0.60), 3 (76% vs 81%, p = 0.54), 6 months (88% vs 92%, p = 0.67) and 12 months (90% vs 92%; p = 0.57), were also comparable. CONCLUSIONS Compared to standard monofilament suture, use of VLOC suture appears to provide a safe, more efficient and cost effective urinary reconstruction during RARP. Use of the interlocked-VLOC suture technique prevents slippage, precluding the need for assistance, knot tying, and constant reassessing of anastomosis integrity. More important, to the best of our knowledge, this is the longest followup with such soft-tissue suture material for urinary reconstruction. Despite initial concern for increased inflammation from delayed material absorption and suture barbs, no adverse outcomes are observed in long-term assessment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e564 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Zorn Montreal, Canada More articles by this author Quoc-Dien Trinh Montreal, Canada More articles by this author Dan Liberman Montreal, Canada More articles by this author Assaad ElHakim Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».