title: V-Loc urethro-intestinal anastomosis during robotic cystectomy with orthotopic urinary diversion.
abstract: BACKGROUND
  Robotic-assisted radical cystectomy (RARC) is an emerging minimally invasive alternative for the treatment of invasive bladder cancer. The V-loc (Covidien, Mansfield, MA) suture is a unidirectional barbed suture that provides even distribution of tension. We determined the rate of urinary leak at the urethro-intestinal anastomosis following orthotopic neobladder construction performed with V-loc suture.
  
  
  METHODS
  We retrospectively reviewed charts on all patients that underwent RARC with orthotopic neobladder urinary diversion performed with a V-loc suture from February 2010 to February 2012. The urethro-intestinal anastomosis was evaluated for urinary leak by cystogram at 3 to 4 weeks, postoperatively.
  
  
  RESULTS
  In total, 11 patients were available for analysis. The mean patient age was 57.2 years (range: 47-71). The average clinical follow-up was 8 months (range: 4-15). On surgical pathology, 8 (73%) patients had pT2 or less disease, 3 (27%) had pT3/T4 disease, and 1 (9%) had N+ disease. The mean intraoperative blood loss was 315 mL (range: 150-600) and the average operative time was 496 minutes (range: 485-519). No patient (0%) demonstrated a urinary leak at the urethro-intestinal anastomosis on postoperative cystogram. Eight patients (73%) were continent by 4 months, postoperatively.
  
  
  CONCLUSIONS
  Orthotopic neobladder urethro-intestinal anastomosis can be performed effectively and safely with V-loc suture with an acceptably low urinary leak rate.
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Khanh N
authors.initials: KN
authors.lastname: Pham
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Sack
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
authors.forename: Michael L
authors.initials: ML
authors.lastname: Guralnick
authors.forename: Peter
authors.initials: P
authors.lastname: Langenstroer
authors.forename: William A
authors.initials: WA
authors.lastname: See
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jacobsohn