title: Posterior reconstruction before anastomosis improves the anastomosis time during robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  Our goal was to evaluate posterior reconstruction of the rhabdosphincter during robot-assisted radical prostatectomy and determine whether this technique decreased anastomotic time of a surgeon in training to perform vesicourethral reconstruction.
  
  
  METHODS
  We reviewed the first 25 robot-assisted prostatectomies performed by 2 urology surgeons in training (surgeon 1 and surgeon 2). The patient populations were matched for age, Gleason score, clinical stage, and PSA. Whereas surgeon 1 performed the vesicourethral anastomosis without posterior reconstruction, surgeon 2 reapproximated Denonvilliers' fascia of the posterior bladder to the rhabdosphincter. Time for each surgeon to complete the anastomosis and clinical factors was compared.
  
  
  RESULTS
  Surgeon 1 had a median anastomosis time of 25 minutes (range, 17 to 48), whereas surgeon 2 had a median anastomosis time of 15 minutes (range, 10 to 30) (P<0.001). Biopsy Gleason score, pathological tumor stage, perineural invasion, median age at the time of surgery, PSA, prostate weight, and estimated blood loss were not significantly different between surgeons (P>0.05). Pathological Gleason score (P=0.045) and total console time (surgeon 1-216 minutes, surgeon 2-176 minutes; P=0.002) were significantly different between surgeons.
  
  
  CONCLUSIONS
  Posterior reconstruction prior to anastomosis decreases anastomosis time for robotic surgeons in training.
authors: Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors: Aaron M
authors: AM
authors: Bernie
authors: Arthur A
authors: AA
authors: Caire
authors: Sarah P
authors: SP
authors: Conley
authors: Mathew
authors: M
authors: Oommen
authors: Ugur
authors: U
authors: Boylu
authors: Raju
authors: R
authors: Thomas
authors: Benjamin R
authors: BR
authors: Lee
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