title: A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients.
abstract: OBJECTIVE
  To describe the safety and feasibility of a running urethrovesical anastomosis (UVA) in robot-assisted radical prostatectomy (RARP) using a unidirectional self-locking barbed suture.
  
  
  METHODS
  Fifty-one consecutive patients with organ-confined prostate cancer underwent RARP by one of two experienced surgeons. UVA was performed in two layers, using a unidirectional barbed suture fashioned into a double-ended stitch. Perioperative outcomes and 30-day complications were recorded.
  
  
  RESULTS
  All anastomoses were performed without assistance and without tying a knot. Median time for entire dual-layer anastomosis was 14.0 minutes (interquartile range [IQR]: 12-20) and that for urethrovesical anastomosis was 11 minutes (IQR: 9-15). Not having to rely on an assistant to follow the suture decreased instrument clashes, entangling of the suture around an instrument, and made the anastomosis faster. Eight patients underwent anterior/lateral reconstruction of the bladder neck, and there were no leaks on cystography at 1 week.
  
  
  CONCLUSIONS
  We describe the first reported clinical experience with a novel technique of performing UVA during RARP that is safe and efficient. Using the barbed wound closure device prevents slippage, precluding the need for assistance, knot tying, and constant reassessing of anastomosis integrity.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA. skaul1@hfhs.org
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D013537:Sutures; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D058106:Wound Closure Techniques / Q000295:instrumentation*