Modified running vesicourethral anastomosis after robotically assisted laparoscopic radical prostatectomy: use of solitary Lapra-Ty to secure posterior approximation.
OBJECTIVE
We describe a novel method of ensuring posterior approximation and preventing urinary leak during the running anastomosis of robotically assisted laparoscopic prostatectomy.


METHODS
Two 3-0 Monocryl RB-1 sutures are tied end-to-end. The undyed suture is placed first at the 5-o'clock position on the bladder side outside-in and then through the urethra at the same location inside-out. Proceeding clockwise, the suture is placed twice more through both the bladder and the urethra. With gentle manipulation, the suture is cinched down to provide secure posterior approximation; however, if tension is released from the suture coming from the urethra, the approximation may loosen and could result in a potential "gap" and site for anastomotic leakage. To prevent potential loosening, tension is maintained on the stitch as a single Lapra-Ty is placed at the base of the suture as it leaves the urethra. When the tension is released, the posterior approximation is tightly maintained and the remaining anastomosis is completed.


RESULTS
We have performed 110 robotically assisted laparoscopic prostatectomies. Six urinary leaks requiring prolonged catheterization were identified in our first 90 patients (6.7%). We have not experienced any urinary leakage or short-term complications in the subsequent 20 patients using this technique.


CONCLUSIONS
We describe a novel technique to ensure secure posterior approximation during the vesicourethral anastomosis after robotically assisted laparoscopic prostatectomy. A single Lapra-Ty clip placed early during the anastomosis prevents potential "gaps" in the approximation that may be the source of troublesome leakage.
Eastern Virginia Medical School and Devine-Tidewater Urology, Norfolk, Virginia, USA.
Adam J
AJ
Ball
Kevin P
KP
Bordeau
John W
JW
Davis
Robert W
RW
Given
Donald F
DF
Lynch
Michael D
MD
Fabrizio
D000714:Anastomosis, Surgical / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D013536:Suture Techniques; D013537:Sutures; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*