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Shehata MA, Negm MA, Shalaby MM, Mansour MA, Elhaddad AA. Unidirectional barbed sutures vs. interrupted intracorporeal knots in thoracoscopic repair of congenital diaphragmatic hernia in pediatrics. Front Pediatr 2024; 12:1348753. [PMID: 38304747 PMCID: PMC10830701 DOI: 10.3389/fped.2024.1348753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background Intracorporeal suturing knots continue to be one of the most challenging and time-consuming steps in the thoracoscopic repair of congenital diaphragmatic hernia (CDH). Barbed unidirectional knotless sutures are designed to shorten surgical procedures by eliminating the need to tie knots. This work aimed to compare unidirectional barbed sutures and interrupted intracorporeal knots in the thoracoscopic repair of CDH in pediatrics regarding the time required to suture, operative time and complications. Methods This retrospective study included 139 patients presented with Bochdalek CDH. Patients were classified into early (neonatal) and late presentations. The hernia defect was repaired by unidirectional Barbed sutures (V-LocTM and StratafixTM sutures) in group B or by Conventional interrupted intracorporeal knots in group C. Results In both early and delayed presentations, the time required to suture (15 and 13 min in group B, 33 and 28 min in group C for neonatal and delayed presentation respectively) was significantly shorter in group B. Complications (visceral perforation, wound infection, and recurrence) insignificantly differed between group B and group C of early presentation. No patients suffered from major complications in both groups. Conclusions Both unidirectional barbed sutures and intracorporeal knots were safe and effective. However, unidirectional barbed sutures are a time-saving choices for CDH thoracoscopic repair in early and late presentations.
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Affiliation(s)
- Mohamed Ali Shehata
- Pediatric Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Ahmed Negm
- Pediatric Surgery Unit, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | | | - Mohamed Awad Mansour
- Pediatric Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Tsuboi I, Ogawa K, Tanaka G, Mitani K, Yoshioka S, Yokoyama S, Nakajima H, Nagami T, Wada K. The efficacy of STRATAFIX® spiral PDS for vesicourethral anastomosis during robot-assisted laparoscopic radical prostatectomy: a single-center retrospective study. Int Urol Nephrol 2024; 56:137-142. [PMID: 37702896 DOI: 10.1007/s11255-023-03775-y] [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] [Received: 07/10/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To investigate the efficacy of continuous suturing using barbed suture for vesicourethral anastomosis (VUA) during robot-assisted laparoscopic radical prostatectomy (RARP). MATERIALS AND METHODS Seventy-three consecutive patients who underwent RARP by a single surgeon between 2020 and 2022 were retrospectively divided based on the suture type used for VUA: group A, 3-0 poliglecaprone-25 RB-1 needle (Monocryl®), n = 46; group B, 3-0 spiral polydioxanone (PDS) barbed suture with RB-1 needle (STRATAFIX®), n = 27. RESULTS There was no significant difference in patient background characteristics between groups, including age, body mass index, and clinical stage. However, group B had a significantly shorter operative time, console time, hospital stay, and duration of urethral catheterization. The VUA time was significantly shorter in group B than in group A (17.9 min vs. 10.6 min; p < 0.001). Only 1 case of minor leakage was observed during the intraoperative leak test (1 patient in group A). There was no significant difference in the number of pads used at 1, 3, 6 months and 1 year postoperatively. There were no urethral strictures, and there was no significant difference in pathologic results or postoperative prostate-specific antigen progression between groups. CONCLUSIONS Our study suggests that the use of barbed suture during VUA for RARP is associated with reduced VUA time.
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Affiliation(s)
- Ichiro Tsuboi
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan.
| | - Kohei Ogawa
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Gen Tanaka
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Kazutaka Mitani
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Saori Yoshioka
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Shuhei Yokoyama
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Hirochika Nakajima
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Taichi Nagami
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Koichiro Wada
- Faculty of Medicine Graduate School of Medicine, Shimane University, Izumo, Shimane, Japan
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Williams EA, Monnet E. Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study. Vet Surg 2023; 52:1009-1014. [PMID: 37332126 DOI: 10.1111/vsu.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/26/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To report the clinical outcomes of gastrointestinal surgery using unidirectional barbed sutures in single-layer appositional closure in dogs and cats. STUDY DESIGN Retrospective and descriptive study. SAMPLE POPULATION Twenty-six client-owned dogs; three client-owned cats. METHODS Medical records of dogs and cats that received gastrointestinal surgery closed with unidirectional barbed sutures were reviewed to collect information on signalment, physical examinations, diagnostics, surgical procedures, and complications. Short- and long-term follow-up information was collected from the medical records, the owners, or the referring veterinarians. RESULTS Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures. Nine dogs had multiple surgical sites closed with unidirectional barbed sutures. None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20-2179 days). Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site. CONCLUSION Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term. CLINICAL SIGNIFICANCE Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.
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Affiliation(s)
- Evan A Williams
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Eric Monnet
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Monnet E, Hafez A. Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study. Vet Surg 2023; 52:716-720. [PMID: 36898966 DOI: 10.1111/vsu.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. STUDY DESIGN Experimental, ex-vivo, randomized study. ANIMALS A total of 24 male canine bladders with the urethra. METHODS Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. RESULTS The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012). CONCLUSION Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. CLINICAL SIGNIFICANCE A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.
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Affiliation(s)
- Eric Monnet
- Department of Clinical Science, Colorado State University, College of Veterinary Medicine and Biomedical Science, Fort Collins, CO, USA
| | - Ahmed Hafez
- Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
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Monnet E, Hafez A. Description of the technique for laparoscopic radical prostatectomy in canine cadavers: 2D vs. 3D camera. PLoS One 2022; 17:e0274868. [PMID: 36445893 PMCID: PMC9707773 DOI: 10.1371/journal.pone.0274868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the technique of laparoscopic radical prostatectomy in canine cadavers. STUDY DESIGN Cadaveric study. ANIMALS 8 canine cadavers. METHODS Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded. RESULTS Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55). CONCLUSION Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter. CLINICAL SIGNIFICANCE Radical prostatectomy with laparoscopy should be considered for dogs.
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Affiliation(s)
- Eric Monnet
- College of Veterinary Medicine, Dept of Clinical Sciences, Colorado State University, Fort Collins, CO, United States of America
- * E-mail:
| | - Ahmed Hafez
- Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
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Anand S, Jukić M, Krishnan N, Pogorelić Z. Barbed Versus Non-Barbed Suture for Pyeloplasty via the Minimally Invasive Approach: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:1056-1063. [PMID: 35549514 DOI: 10.1089/lap.2021.0868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | | | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, University of Split, School of Medicine, Split, Croatia
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Manfredi M, Fiori C, Amparore D, Checcucci E, Porpiglia F. Technical details to achieve perfect early continence after radical prostatectomy. MINERVA CHIR 2019; 74:63-77. [DOI: 10.23736/s0026-4733.18.07761-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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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: 0.5] [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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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: 1.3] [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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Umranikar SA, Ubee SS, Selvan M, Cooke P. Barbed suture tissue closure device in urological surgery – a comprehensive review. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817702315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development and implementation of barbed sutures has transformed the technique of tissue closure with increasing application across multiple surgical disciplines. Changes in design and handling such as the introduction of absorbable and non-absorbable bidirectional barbed sutures reflect an increasing applicability in tissues of varying qualities. We undertook a comprehensive review of available literature to provide an evidence-based rationale for the clinical use of barbed suture tissue closure devices. We summarise uses along with advantages and disadvantages reported across a number of surgical specialties such as urology, orthopaedics, gynaecology and plastic surgery. Tangible benefits noted were faster closure speed, maintenance of suture integrity, improved efficiency in closure, avoidance of knots and possibly a cost-benefit effect. In terms of complications, the barbed sutures compared equally with standard sutures with no significant differences. In conclusion, barbed sutures have demonstrated versatility and safety across surgical specialties and compares favourably with standard sutures. There appears to be an increasing popularity in the use of barbed sutures with clear advantages to both surgeon and patient.
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Affiliation(s)
- Salil A Umranikar
- Department of Urology, University Hospital of North Midlands NHS Trust, UK
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Sarvpreet S Ubee
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Masilamani Selvan
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Peter Cooke
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
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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: 1.8] [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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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: 9.0] [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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Jeong W, Kumar R, Menon M. Past, present and future of urological robotic surgery. Investig Clin Urol 2016; 57:75-83. [PMID: 26981588 PMCID: PMC4791673 DOI: 10.4111/icu.2016.57.2.75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 12/17/2022] Open
Abstract
The first urologic robotic program in the world was built at the Vattikuti Urology Institute, Henry Ford Hospital Detroit, Michigan, in 2000 under the vision of surgical innovator, Dr. Mani Menon for the radical prostatectomy. The robot-assisted radical prostatectomy continues being modified with techniques to improve perioperative and surgical outcomes. The application of robotic surgical technique has since been expanded to the bladder and upper urinary tract surgery. The evolution of surgical technique and its expansion of application will continue to improve quality, outcome parameters and experience for the patients.
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Affiliation(s)
- Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
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Continuous suture of a single absorbable suture: a new simplified vesicourethral anastomosis technique in laparoscopic radical prostatectomy. Int Surg 2016; 99:656-61. [PMID: 25216438 DOI: 10.9738/intsurg-d-13-00124.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to describe a new simplified technique for facilitating vesicourethral anastomosis in laparoscopic radical prostatectomy. After prostate removal, an approximately 15-cm-long absorbable suture with one three-eighths arc needle is passed from the outside in on the full thickness of the bladder neck at the 9 o'clock position and then from inside out on the full thickness of the urethra at the 9 o'clock position. It is knotted with the suture tail. Subsequently, a continuous suture is completed between the bladder neck and urethra. A 20-French silastic catheter is placed into the bladder before completing the anterior row of sutures. Three hundred twelve consecutive patients with localized prostate cancer who had undergone the new simplified vesicourethral anastomosis were included in this retrospective study. The average time of anastomosis was 10.5 minutes (range, 8-30 minutes), as recorded for an experienced laparoscopic surgeon. The incidence rate was 2.2% for urine leakage and 1.3% for bladder neck stenosis, and the continence rate was 86.9% at 1 month, 93.3% at 3 months, 98.1% at 6 months, and 98.7% at 1 year. We present a new simplified method for vesicourethral anastomosis. The method takes little operating time and is easy for novice laparoscopists to master. Moreover, this technique has low rates of urinary leakage and bladder neck stricture.
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Abdollah F, Menon M. The Technique of Robotic Nerve-Sparing Prostatectomy. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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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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Lukish J, Pryor H, Rhee D, Salazar J, Goldstein S, Gause C, Stewart D, Abdullah F, Colombani P. A novel continuous stitch fundoplication utilizing knotless barbed suture in children with gastroesophageal reflux disease: a pilot study. J Pediatr Surg 2015; 50:272-4. [PMID: 25638617 DOI: 10.1016/j.jpedsurg.2014.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The intracorporeal placement and tying of suture (IT) can be challenging leading to prolonged CO2 insufflation, anesthesia, and potential morbidity. The unidirectional barbed knotless suture (V-LOC) has emerged as an innovative technology that has been shown to reduce the time associated with IT. Therefore, we conducted a retrospective analysis comparing our initial experience utilizing V-LOC to perform a novel continuous stitch laparoscopic fundoplication (CF) to standard laparoscopic Nissen fundoplication (NF). METHODS Institutional review board approval was obtained to analyze data on patients who underwent V-LOC CF and NF. Data retrieval included age, gender, weight, diagnosis, procedure, operative time, major complications (reoperation for wrap failure/migration or recurrent symptoms), and follow up. RESULTS Twenty patients underwent the V-LOC CF and gastrostomy placement (GT) from January to October 2013. Seventeen patients underwent NF and GT from March 2012 to February 2013. There were no significant differences in age, weight, or incidence of major complications. V-LOC CF led to a significant 30% reduction in operative time compared to NF (79.1±24.2 min vs. 113.8±25.9 min, respectively, P<0.05). CONCLUSIONS This is the first report documenting the continuous stitch fundoplication utilizing the unidirectional barbed knotless suture in children. Although follow-up is short, the V-LOC CF appears to be a safe and effective technique that may reduce operative time in children with gastroesophageal reflux disease. This technology may be beneficial in other minimally invasive applications in pediatric surgery.
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Affiliation(s)
- Jeffrey Lukish
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States.
| | - Howard Pryor
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Daniel Rhee
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Jose Salazar
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Seth Goldstein
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Colin Gause
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Dylan Stewart
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
| | - Paul Colombani
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States
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20
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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. The growth of computer-assisted (robotic) surgery in urology 2000-2014: The role of Asian surgeons. Asian J Urol 2015; 2:1-10. [PMID: 29264114 PMCID: PMC5730690 DOI: 10.1016/j.ajur.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/28/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022] Open
Abstract
Objective A major role in the establishment of computer-assisted robotic surgery (CARS) can be traced to the work of Mani Menon at Vattikuti Urology Institute (VUI), and of many surgeons of Asian origin. The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines, improving patient comfort and disease outcomes and helping the industrial growth. The present paper gives an overview of the progress and development of robotic surgery, especially in the field of Urology; and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world. Methods PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014, using algorithms based on keywords “robotic surgery”, ”prostate”, “kidney”, “adrenal”, “bladder”, “reconstruction”, and “kidney transplant”. Inclusion criteria used were published full articles, book chapters, clinical trials, prospective and retrospective series, and systematic reviews/meta-analyses written in English language. Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion, and focused on techniques of robotic surgery, relevant patient outcomes and associated demographic trends. Results A total of 58 articles selected for final review highlight the important strides made by robots in urology, from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014. In the hands of an experienced robotic surgeon, it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery, especially in urologic oncology and reconstructive urology. With increasing surgeon proficiency, the benefits of robotic surgery were consistently seen across different surgical disciplines, patient populations, and strata. Conclusion The addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.
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Affiliation(s)
- Deepansh Dalela
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Rajesh Ahlawat
- Medanta Hospitals - Medanta Vattikuti Urology Institute, Gurgaon, Haryana, India
| | - Akshay Sood
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Wooju Jeong
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mahendra Bhandari
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mani Menon
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. WITHDRAWN: The growth of computer-assisted (robotic) surgery in urology 2000–2014: The role of Asian surgeons. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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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: 0.8] [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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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: 1.4] [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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24
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Nakanishi R, Shinohara S, Yamashita T, Oyama T, Hanaka T, Kuboi S. Advances in the use of video-assisted thoracoscopic lobectomy in lung cancer: sleeve bronchoplasty and arterioplasty. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This article focuses on the technical strategies for performing sleeve bronchoplasty and pulmonary arterioplasty as advances in the application of video-assisted thoracoscopic surgery (VATS) as lobectomy with bronchovascular reconstruction is a favorable alternative to pneumonectomy in terms of the pulmonary function. When performing VATS sleeve bronchoplasty or arterioplasty, several technical issues should be discussed, including how to reduce the anastomotic tension of the airway, perform bronchial anastomosis, and clamp the pulmonary artery and select the type of vascular clamp. The traction device technique and continuous suture technique are thought to help surgeons perform VATS sleeve bronchoplasty, while cross-clamping of the pulmonary artery using thoracoscopic instruments aids in carrying out VATS arterioplasty.
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Affiliation(s)
- Ryoichi Nakanishi
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Shinji Shinohara
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Toshihiro Yamashita
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Tsunehiro Oyama
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Tetsuya Hanaka
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Satoshi Kuboi
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
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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: 2.7] [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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26
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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: 3.8] [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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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: 2.9] [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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Lukish J, Rasmussen S, Garrett D, Stewart D, Buck J, Abdullah F, Colombani P. Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery. J Pediatr Surg 2013; 48:1445-9. [PMID: 23845647 DOI: 10.1016/j.jpedsurg.2013.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/29/2013] [Accepted: 03/01/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND The application of minimally invasive surgery (MIS) for advanced procedures in children is logical. However, the intracorporeal placement and tying of suture can be challenging, leading to prolonged anesthesia and morbidity. We describe our initial experience with the use of a novel unidirectional barbed knotless suture (V-LOC, Covidien, Mansfield, MA) that permits a safe and efficient advanced MIS reconstruction in infants and children. METHODS From August 2010 to February 2012, 11 infants and children underwent diaphragmatic reconstruction utilizing either the absorbable or the permanent V-LOC suture. Data retrieval included gender, weight, diagnosis, operative time, complications and follow up. RESULTS Thoracoscopic or laparoscopic repairs were carried out in all children. Two of the infants with congenital diaphragmatic hernia of Bochdalek (CDH) developed a recurrence at 4 and 6 months of age and required reoperation. There were no other complications or recurrence in the remaining 9 children, and there were no mortalities in the group. CONCLUSION This is the first study to evaluate the use of the unidirectional barbed knotless suture in pediatric surgery. We demonstrate that the use of the V-LOC barbed suture is an innovative, safe and time saving option for pediatric MIS. Prospective analysis with long-term follow-up is required to confirm these initial results and to ascertain if this novel approach can be utilized in other pediatric surgical conditions.
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Affiliation(s)
- Jeffrey Lukish
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA.
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29
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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: 1.7] [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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30
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Ghani KR, Trinh QD, Menon M. Vattikuti Institute Prostatectomy-Technique in 2012. J Endourol 2013; 26:1558-65. [PMID: 23230869 DOI: 10.1089/end.2012.0455] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This year marks 12 years of the world's first robot-assisted radical prostatectomy (RARP) program, the Vattikuti Institute Prostatectomy (VIP). Experience with more than 7000 cases has helped standardize the operation, minimize complications, and enhance functional outcomes. In this article, we discuss our current technique of VIP including refinements such as Veil of Aphrodite nerve sparing using Harmonic ACE curved shears, high anterior release (super Veil), extended pelvic lymph node dissection, percutaneous suprapubic tube bladder drainage, and barbed suture for the urethrovesical anastomosis. In 2012, incorporation of the GelPoint access platform has the potential to further improve the oncologic performance of VIP, especially in high-risk patients.
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Affiliation(s)
- Khurshid R Ghani
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
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31
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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: 43] [Impact Index Per Article: 3.6] [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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Erdem S, Tefik T, Mammadov A, Ural F, Oktar T, Issever H, Nane I, Sanli O. The use of self-retaining barbed suture for inner layer renorrhaphy significantly reduces warm ischemia time in laparoscopic partial nephrectomy: outcomes of a matched-pair analysis. J Endourol 2013; 27:452-8. [PMID: 23157211 DOI: 10.1089/end.2012.0574] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the efficacy of self-retaining barbed suture (SRBS) on reducing renorrhaphy time and warm ischemia time (WIT) during laparoscopic partial nephrectomy (LPN), in comparison with conventional polyglactin suture. PATIENTS AND METHODS Between February 2008 and June 2012, 115 patients underwent LPN for renal tumors at our institution. Among them, the patients whose inner layer renorrhaphy was performed using SRBS (group 1, n=33) or polyglactin suture (group 2, n=33) were retrospectively identified from prospectively collected institutional laparoscopic database (unmatched comparison). Furthermore, 17 patients from each group were matched at a 1:1 ratio in terms of sex, age, body mass index, preoperative aspects and dimensions used for an anatomic (PADUA) classification scoring system, and operative approach (transperitoneoscopic/retroperitoneoscopic) to eliminate the effects of these variables on WIT (matched-pair comparison). Demographic, perioperative, and pathologic parameters were evaluated between groups in both unmatched and matched-pair comparison. RESULTS The perioperative parameters including inner layer renorrhaphy time, WIT, estimated blood loss, operative time, length of hospital stay, and complication rate were not statistically different between the two groups in the unmatched comparison. Median PADUA score (9 vs 8, P=0.006), median preoperative (4 cm vs 3.6 cm, P=0.049), and pathologic (4.5 cm vs 3.5 cm, P=0.009) tumor size, however, were significantly higher in group 1. In the matched-pair analysis, inner layer renorrhaphy time (350 sec vs 505 sec, P=0.004) and WIT (19 min vs 28 min, P=0.037) were significantly reduced with the use of SRBS in group 1 without a difference of median PADUA score (8 vs 8, P=1), median preoperative (3.8 cm vs 4 cm, P=0.959), and pathologic (4.2 cm vs 4 cm, P=0.284) tumor size. CONCLUSIONS The SRBS significantly reduced inner layer renorrhaphy time and WIT during LPN and may enable urologists to perform LPN in more challenging and larger tumors, in comparison with conventional polyglactin suture.
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Affiliation(s)
- Selcuk Erdem
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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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: 1.4] [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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Manganiello M, Kenney P, Canes D, Sorcini A, Moinzadeh A. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy. Int Braz J Urol 2012; 38:89-96. [PMID: 22397770 DOI: 10.1590/s1677-55382012000100013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE V-Loc™180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl™ (Ethicon, Somerville, NJ). MATERIALS AND METHODS Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc™180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc™180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident. CONCLUSIONS Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc™180 was associated with improved early continence, this difference was transient.
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Hansen LA, Monnet EL. Evaluation of a novel suture material for closure of intestinal anastomoses in canine cadavers. Am J Vet Res 2012; 73:1819-23. [DOI: 10.2460/ajvr.73.11.1819] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Partial nephrectomy: is there an advantage of the self-retaining barbed suture in the perioperative period? A matched case-control comparison. World J Urol 2012; 30:659-64. [PMID: 22956042 DOI: 10.1007/s00345-012-0933-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/16/2012] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of the self-retaining barbed suture (SRBS) in renal defect repair during partial nephrectomy (PN), by assessing perioperative outcomes. METHODS From June 2010 on we have been using the SRBS for superficial layer closure during open and laparoscopic PN in two European centers. These data were collected prospectively and matched with historical PN cases performed with conventional suture. Cases were matched for PADUA score, surgical approach (laparoscopic or open) and the center where surgery was performed. Comparisons were made in patient characteristics and perioperative outcomes including warm ischemia time (WIT), changes in hemoglobin (Hb), changes in estimated glomerular filtration rate (eGFR) and perioperative complications between the SRBS and non-SRBS groups. Statistical tests of significance were performed using Student's t test and chi-square test for continuous and categorical variables, respectively. RESULTS Thirty-one consecutive cases of PN under WIT were performed with SRBS. These cases were matched with cases from the historical database of PN performed with conventional suture. The rate of perioperative complications was statistically significantly lower in the SRBS cohort (6.5 vs. 22.6 %, p = 0.038). Mean ischemia time was 19.6 min (SD, 7.5) in the SRBS group versus 21.8 min (SD, 9.5) in the conventional suture group (p = 0.312). There were no significant differences between groups for postoperative changes in creatinine, eGFR and Hb. Limitations of this study include the absence of randomization and the relative small sample size. CONCLUSIONS SRBS can be safely used during partial nephrectomy. SRBS reduces significantly the number of perioperative complications.
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Ghani KR, Trinh QD, Sammon J, Jeong W, Dabaja A, Menon M. Robot-assisted urological surgery: Current status and future perspectives. Arab J Urol 2012; 10:17-22. [PMID: 26558000 PMCID: PMC4442903 DOI: 10.1016/j.aju.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022] Open
Abstract
Objectives To discuss the current status of robot-assisted urological surgery. Methods We searched PubMed for articles published from 2008 using the search terms ‘advances’, ‘robotic surgery equipment’ and ‘instrumentation’. We also searched PubMed for articles describing the latest developments in reconstructive techniques for lower and upper urinary tract procedures. Finally, we searched PubMed for original articles containing the terms ‘robotic surgery training’ and ‘credentialing’. Results With each release of hardware or ancillary instrumentation, the reconstructive abilities of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) improve. Recent developments in reconstructive capabilities of robotic urological surgery include posterior reconstruction during robot-assisted radical prostatectomy, barbed sutures for urethrovesical anastomosis, sliding-clip renorrhaphy for robot-assisted partial nephrectomy, and repair of pelvic organ prolapse. The safe implementation of robotic surgery is aided by new guidelines in credentialing and proctoring, and the introduction of virtual reality simulators for training. Conclusion Robotic urological surgery is rapidly developing and expanding globally. To achieve the highest levels of safety for patients, surgeons must ensure that the implementation of robotic surgery is an integrative and effective process.
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Affiliation(s)
- Khurshid R Ghani
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Quoc-Dien Trinh
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Jesse Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Ali Dabaja
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
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Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho R, Palmer K, Davila H, Patel V. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot-assisted radical prostatectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2012.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho R, Palmer K, Davila H, Patel V. [Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy]. Actas Urol Esp 2012; 36:69-74. [PMID: 21889821 DOI: 10.1016/j.acuro.2011.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 10/26/2022]
Abstract
BACKGROUND The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. OBJECTIVE To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. MATERIAL AND METHODS The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture RESULTS All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. CONCLUSION The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.
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Zorn KC, Trinh QD, Jeldres C, Schmitges J, Widmer H, Lattouf JB, Sammon J, Liberman D, Sun M, Bianchi M, Karakiewicz PI, Denis R, Gautam G, El-Hakim A. Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int 2012; 109:1526-32. [PMID: 22221566 DOI: 10.1111/j.1464-410x.2011.10763.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Study Type - RCT (randomized trial) Level of Evidence 2b. What's known on the subject? and What does the study add? In a previous randomized controlled trial, barbed polyglyconate suture for vesico-urethral anastomosis was associated with more frequent cystogram leaks, longer mean catheterization times and greater suture costs per case. In the current randomized controlled trial, we show that barbed polyglyconate suture is associated with decreased anastomosis time, decreased need to readjust suture tension, cost reduction, and equal continence and early/late urinary complication rates. OBJECTIVE To examine the effectiveness of barbed polyglyconate suture (V-Loc 180; Covidien, Mansfield, MA, USA) compared with standard monofilament for posterior reconstruction (PR) and vesico-urethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS A prospective randomized controlled trial was conducted in 70 consecutive RARP cases by a single surgeon (K.C.Z.). Standard VUA was performed using three 4-0 poliglecaprone 25 (Monocryl; Ethicon Endosurgery, Cincinnati, OH, USA) sutures secured with absorbable suture clips (LapraTy, Ethicon; one single 6-inch [15.2 cm] for PR and two attached 6-inch [15.2 cm] for VUA). Barbed suture VUA was performed using two 3-0 6-inch (15.2 cm) barbed polyglyconate sutures. Time to complete the suture set-up by the nursing team, anastomosis time and need to adjust suture tension were recorded. Suture-related complications, validated-questionnaire continence and cost were also examined. RESULTS Compared with a conventional reconstruction technique, there was a significant reduction in mean nurse set-up time (31 vs. 294 s; P < 0.01) and reconstruction time (13.1 vs. 20.8 min; P < 0.01) for the barbed suture technique. Need to readjust suture tension or to place additional suture clips for watertight closure was greater in the standard monofilament group than in the barbed suture group (6% vs. 24%; P= 0.03). • A cost reduction was recorded at our institution (48.05 vs. 70.25 $CAN) with the barbed suture technique. • With a mean follow-up of 6.2 months, no delayed anastomotic leak or bladder neck contracture was observed in either group. • Pad-free continence outcomes for the monofilament suture vs the barbed suture groups at 1 (64 vs. 69%, P= 0.6), 3 (76 vs. 81%, P= 0.5) and 6 months (88 vs. 92%, P= 0.7) were similar. CONCLUSIONS • Compared with standard monofilament suture, the unidirectional barbed polyglyconate suture appears to provide safe, efficient and cost-effective PR and VUA during RARP. • Use of the interlocked barbed polyglyconate suture technique prevents slippage, precluding the need for assistance, knot-tying and constant reassessment of anastomosis integrity.
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Affiliation(s)
- Kevin C Zorn
- University of Montreal Hospital Center, Hôpital Sacré-Coeur de Montréal, QC, Canada
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Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience. Int Urol Nephrol 2011; 44:775-85. [DOI: 10.1007/s11255-011-0075-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
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Rogers CG, Peabody JO. Reply. Urology 2011. [DOI: 10.1016/j.urology.2011.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Use of a barbed suture for continuous urethro-vesical anastomosis during robot-assisted laparoscopic radical prostatectomy. J Robot Surg 2011; 6:241-2. [DOI: 10.1007/s11701-011-0299-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
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Sammon J, Kim TK, Trinh QD, Bhandari A, Kaul S, Sukumar S, Rogers CG, Peabody JO. Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology 2011; 78:572-9. [PMID: 21782218 DOI: 10.1016/j.urology.2011.03.069] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 03/17/2011] [Accepted: 03/26/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare perioperative and functional outcomes after urethrovesical anastomosis (UVA) with barbed polyglyconate and monofilament poliglecaprone in robot-assisted radical prostatectomy (RARP). Barbed polyglyconate suture was first used for the UVA during RARP beginning in January 2010; safety and feasibility were previously demonstrated in 51 patients. METHODS From May to September 2010, 64 patients meeting all the inclusion criteria participated in the present multisurgeon prospective, randomized, controlled trial and underwent posterior repair and UVA during RARP with either barbed polyglyconate (n=33) or monofilament poliglecaprone (n=31) suture. The primary outcomes were the anastomotic (UVA) and posterior reconstruction times. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by a self-administered validated patient questionnaire. RESULTS Posterior reconstruction was performed within 3.3 minutes with the barbed suture versus 4.3 minutes with the monofilament poliglecaprone suture (23.3% reduction) and UVA within 10.1 versus 13.8 minutes, respectively (26.8% reduction). The absolute time difference for the 2-layer anastomosis was 4.7 minutes (a 26.0% reduction in the total anastomosis time). All other perioperative outcomes were equivalent between the 2 groups. Urinary functional outcomes, including the pad use and leakage rates, were equivalent at 6 weeks. CONCLUSION Anastomosis during RARP with the V-Loc barbed suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 26% decrease in the anastomotic time with no increase in the adverse events, no instances of urinary retention and equivalent functional outcomes were measured with the self-administered patient questionnaire.
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Affiliation(s)
- Jesse Sammon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA.
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Zorn KC, Widmer H, Lattouf JB, Liberman D, Bhojani N, Trinh QD, Sun M, Karakiewicz PI, Denis R, El-Hakim A. 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. Can Urol Assoc J 2011; 5:188-94. [PMID: 21672482 DOI: 10.5489/cuaj.10194] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE : Our purpose was to describe the safety and feasibility of a running posterior reconstruction (PR) integrated with continuous vesicourethral anastomosis (VUA) using a novel self-cinching unidirectional barbed suture in robot-assisted radical prostatectomy (RARP). METHODS : Between March and October 2010, 30 consecutive patients with organ-confined prostate cancer underwent RARP by an experienced single surgeon (KCZ). Upon completion of radical prostatectomy, urinary reconstruction was carried out using 2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The left tail of the suture was initially used for PR (starting at 5-o'clock and ran to re-approximate the retrotrigonal layer to the rectourethralis) followed by left-sided VUA (from 6- to 12-o'clock), while the right-sided suture completed the right-sided VUA. Assurance of watertight closure with an intraoperative 300 cc saline visual cystogram was performed in all cases prior to case completion. Perioperative outcomes and 30-day complications were recorded. RESULTS : All anastamoses were performed without assistance and without knot tying. Median time for nurse setup and urinary reconstruction was 40 seconds (interquartile range [IQR] 25-60) and 14.6 min (IQR 10-18), respectively. The need to readjust suture tension 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 retention after catheter removal on mean postoperative day 5 (IQR 4-6). CONCLUSIONS : Our clinical experience with a novel technique using the interlocked V-Loc suture during RARP for both PR and anastomosis appears to be safe and efficient. Using the barbed suture prevents slippage and eliminates the need for bedside assistance to maintain suture tension or knot tying, thus assuring watertight tissue closure.
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Affiliation(s)
- Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal, Sacre-Coeur de Montreal Hospital, Montreal, QC
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Robotic-assisted laparoscopic prostatectomy: a critical analysis of its impact on urinary continence. Curr Opin Urol 2011; 21:185-94. [DOI: 10.1097/mou.0b013e3283455a21] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hemal AK, Agarwal MM, Babbar P. Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 2011; 44:125-32. [PMID: 21523325 DOI: 10.1007/s11255-011-9967-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of unidirectional barbed suture on vesicourethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP) and its comparison with Polyglecaprone-25 suture. PATIENTS AND METHODS The study was initiated as pilot study; the participants were grouped into three based on the suture material used for VUA, i.e., monofilament Polyglecaprone-25 (group 1), unidirectional barbed Glycolic acid-trimethylene carbonate (group 2), and bidirectional barbed Polyglycolic acid-polycaprolactone (group 3), respectively. Group 1 was included retrospectively and the latter two prospectively. All cases were operated upon by the same surgeon, proficient in RARP. Patient-demographics, intraoperative and peri-operative data were collected. Our technique of mucosa-to-mucosa VUA is carried out in a choreographed manner using unibarbed suture. RESULTS Fifty-five patients were included; 25 each in group 1 and 2. The group 3 was prematurely closed after 5 cases due to perceived inappropriateness of needle characteristics of the suture material. Therefore, the statistical analysis was performed between group 1 and 2 only. Preoperative characteristics including age, PSA, clinical stage, and biopsy grade were similar between the groups. The anastomosis time was significantly less in group 2 (8.4 ± 1.7 min vs. 14.3 ± 4.8 min; P = 0.0001; t test). Postoperative hospital stay was less in group 2 (2.7 ± 1.1 days vs. 1.9 ± 0.8 days; P = 0.023; Mann-Whitney U). None of the patient had presented with urinary leaks, urinary retention, or anastomotic strictures at follow-up of 6 months. CONCLUSION VUA with unidirectional barbed suture is safe and takes less time compared to monofilament suture as repeated cinching; help of assistance and knot tying are not required by virtue of its self-retaining characteristics.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Sammon J, Petros F, Sukumar S, Bhandari A, Kaul S, Menon M, Rogers C. Barbed Suture for Renorrhaphy During Robot-Assisted Partial Nephrectomy. J Endourol 2011; 25:529-33. [DOI: 10.1089/end.2010.0455] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jesse Sammon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Firas Petros
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Shyam Sukumar
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Akshay Bhandari
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Sanjeev Kaul
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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Reply. Urology 2010. [DOI: 10.1016/j.urology.2010.06.020] [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]
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