title: Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA. jsammon79@gmail.com
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Tae-Kyung
authors.initials: TK
authors.lastname: Kim
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D004146:Dioxanes; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers; D011183:Postoperative Complications; D011468:Prostatectomy; D012371:Robotics; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013537:Sutures; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology
chemical_list: D004146:Dioxanes; D011091:Polyesters; D011108:Polymers; C095495:glycolide E-caprolactone copolymer; C046409:polyglyconate