Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture
Bibliographic record
Abstract
Purpose: Our purpose was to describe the safety and feasibility ofa running posterior reconstruction (PR) integrated with continuousvesicourethral anastomosis (VUA) using a novel self-cinchingunidirectional barbed suture in robot-assisted radical prostatectomy(RARP).Methods: Between March and October 2010, 30 consecutivepatients with organ-confined prostate cancer underwent RARP byan experienced single surgeon (KCZ). Upon completion of radicalprostatectomy, urinary reconstruction was carried out using2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The lefttail of the suture was initially used for PR (starting at 5-o’clockand ran to re-approximate the retrotrigonal layer to the rectourethralis)followed by left-sided VUA (from 6- to 12-o’clock), whilethe right-sided suture completed the right-sided VUA. Assuranceof watertight closure with an intraoperative 300 cc saline visualcystogram was performed in all cases prior to case completion.Perioperative outcomes and 30-day complications were recorded.Results: All anastamoses were performed without assistance andwithout knot tying. Median time for nurse setup and urinary reconstructionwas 40 seconds (interquartile range [IQR] 25-60) and14.6 min (IQR 10-18), respectively. The need to readjust suturetension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati,OH) to establish watertight closure was observed in 2 cases (7%).No patient had clinical urinary leak and there was no urinary retentionafter catheter removal on mean postoperative day 5 (IQR 4-6).Conclusions: Our clinical experience with a novel technique usingthe interlocked V-Loc suture during RARP for both PR and anastomosisappears to be safe and efficient. Using the barbed sutureprevents slippage and eliminates the need for bedside assistanceto maintain suture tension or knot tying, thus assuring watertighttissue closure.Objectif : Notre but était de décrire l’innocuité et la faisabilitéd’une reconstruction postérieure (RP) intégrée à une anastomosevésico-urétrale continue à l’aide de la nouvelle technique de sutureavec fils barbelés unidirectionnels et ancrage automatique aprèsprostatectomie radicale assistée par robot (PRAR).Méthodologie : Entre mars et octobre 2010, 30 patients consécutifsatteints d’un cancer de la prostate confiné à la glande ont subi unePRAR effectuée par un chirurgien expérimenté (KCZ). Après laprostatectomie radicale, une reconstruction urinaire a été entrepriseà l’aide de 2 sutures 3-0 de 6 pouces sans noeud par le dispositifV-Loc 180. L’extension gauche de la suture a d’abord été utiliséepour la PR (en commençant à 5 heures et en poursuivant pourrapprocher la couche rétrotrigonale du muscle recto-urétral) etsuivie d’une anatostomose vésico-urétrale du côté gauche (de 6 à12 heures), alors que la partie droite de la suture a permis de terminerl’anastomose vésico-urétrale droite. Une fermeture hermétiquepar cystogramme visuel intraopératoire avec 300 mL de solutionsalée dans tous les cas a été réalisée avant la fin de l’intervention.Les résultats peropératoires et les complications émergeant pendantles 30 jours suivants ont été consignés.Résultats : Toutes les anastomoses ont été effectuées sans aide etsans noeud. Le temps médian pour la préparation par l’infirmièreet la reconstruction urinaire était de 40 secondes (écart interquartile[EIQ] 25-60) et de 14,6 minutes (EIQ 10-18), respectivement.Dans 2 cas (7%), on a eu besoin de rajuster la tension des pointsde suture ou de placer des agrafes LapraTy (Ethicon Endo-Surgery,Cincinnati, OH) pour assurer une fermeture hermétique. Aucunpatient n’a présenté de fuite urinaire clinique ni aucune rétentionurinaire après le retrait du cathéter en moyenne 5 jours aprèsl’opération (EIQ 4-6).Conclusions : Selon notre expérience clinique, cette nouvelle techniquede fermeture de plaie par le dispositif V-Loc pour une PRARavec anastomose semble sans danger et efficace. L’usage des fils barbelés empêche le glissement et élimine le besoin d’aide afind’assurer la bonne tension des points de suture ou de noeuds, etassure une fermeture hermétique des tissus.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".