Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot / Bidirectional Barbed Suture for Bladder Neck Reconstruction, Posterior Reconstruction and Vesicourethral Anastomosis During Robot Assisted Radical Prostatectomy

Antecedentes: La anastomosis uretrovesical es un paso exigente de la prostatectomía radical asistida por robot (PRAR). La imposibilidad de lograr una anastomosis hermética se asocia con la pérdida urinaria postoperatoria y sus consecuencias, que incluyen el íleo paralítico, la cateterización prolongada, la peritonitis urinaria y posiblemente la reintervención. La sutura barbada bidireccional es una tecnología nueva que puede llegar a mejorar la calidad de la anastomosis uretrovesical. Objetivo: Presentar nuestra técnica quirúrgica de la anastomosis uretrovesical, la reconstrucción del cuello vesical y la reconstrucción posterior utilizando una sutura barbada bidireccional. Materiales y métodos: La reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral se realizaron con una sutura barbada monofilamento bidireccional absorbible sintético 2-0. Resultados: Todos los casos se completaron con éxito, sin complicaciones graves o conversiones a cirugía laparoscópica o abierta. Conclusión: Los autores cambiamos con éxito la técnica PRAR para aprovechar las propiedades de la sutura barbada bidireccional. Estudios comparativos que evalúen los resultados objetivos, como el índice de pérdida y el tiempo de la operación, son necesarios para establecer definitivamente los beneficios de este dispositivo en comparación con el monofilamento absorbible tradicional (AU)

Background: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. Objective: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. Material and methods: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture. Results: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. Conclusion: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leak age rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament (AU)

[Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy]. / Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot.

BACKGROUND: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. OBJECTIVE: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. MATERIAL AND METHODS: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture RESULTS: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. CONCLUSION: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.