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V24 A new single barbed bidirectional suture (Filbloc, Assut SPA) for posterior muscolofascial reconstruction and knotless urethrovesical anastomosis during RARP
V24
A new single barbed bidirectional suture (Filbloc, Assut SPA) for posterior muscolofascial reconstruction and knotless urethrovesical anastomosis during RARP Eur Urol Suppl 2016;15(3);eV24
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Schiavina R.1 , Bianchi L. 1 , Salvaggio A. 2 , Borghesi M. 1 , Cappa E. 2 , Dente D.2 , Brunocilla E. 1 , Dababneh H.1 , Chessa F.1 , Caffarelli A. 2 , Vagnoni V. 1 , Pultrone C.V. 1 , Giampaoli M. 1 , Martorana G.1 , Porreca A. 2 1 University
of Bologna-S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy, 2 Policlinic of Abano Terme, Dept. of Urology, Abano
Terme, Italy INTRODUCTION & OBJECTIVES: Barbed sutures are generally used during Robot-Assisted Radical Prostatectomy (RARP) for improving results of Urethro-Vesical Anastomosis (UVA); Posterior Muscolofascial Reconstruction (PMFR) help reducing the bleeding in the anastomotic area, increase the stability of the anastomosis and probably improving the early recovery of urinary continence. The aim of this study is to describe the technique of UVA and PMFR with a new single barbed bidirectional suture during RARP. MATERIAL & METHODS: From January 2012 to October 2015, 451 consecutive PCa patients, underwent RARP in two different urological centres. A 35-cm single 3/0 bi-directional barbed suture with two stitches (Fillbloc TM , Assut SPA) is used for PMFR and UVA. In the first step we suture the posterior layer of the Denonvilliers Fascia (DF) to the recto-urethral muscle with three passages of the two needles (two passage with the left stitch and one with the right one); the two ends of the sutures are gently pulled simultaneously. In the second step, the posterior edge of the bladder neck is sutured to the posterior edge of the urethra with the left end of the suture with two stitches from left to right; the step is completed with a third stitch using the right end of the suture. Then the longer suture is crossed from the right to the left side through the posterior plate of the anastomosis in order to block the sutures. In the third step, the UVA is completed with the left end of the suture starting clockwise from 7 to 12 o’clock and with the right end of the suture anticlockwise from 5 to 12 o’clock. All patients had complete perioperative and follow up data including the recovery of urinary continence (defined as no pad or 1 safety pad per day). RESULTS: The median (IQR) catheterization time and hospital stay were 4.1 (3-6) and 3.5 (3-8) days, respectively. The median (IQR) time of PMFR, UVA and overall technique was 3 min (2-5), 16 min (12-19) and 19 min (11-38) respectively. No intraoperative complications have been observed related to this phase of the RARP. Overall 5 patients (1%) experienced acute urinary retention, 4 (0.9%) had urinary leakage requiring catheterization and no stricture was recorded at 12 months of follow up. After the catheter removal, the recovery of the continence at 3 and 7 days was 60.5 and 75.8%, respectively, while the recovery of continence at 1, 3 and 12 months was 90.2, 97.6 and 98.4%. The median time to continence was 5.2 days. CONCLUSIONS: The technique of PMFR and UVA with the new single barbed suture is easy and reproducible with good results in terms postoperative complications. The single suture allows reproducing all the steps of PMFR and UVA of RARP in a very simple way and with short operative time, with good postoperative results.
A new single barbed bidirectional suture (Filbloc, Assut SPA) for posterior muscolofascial reconstruction and knotless urethrovesical anastomosis during RARP Eur Urol Suppl 2016;15(3);eV24
Print! Print!
Schiavina R.1 , Bianchi L. 1 , Salvaggio A. 2 , Borghesi M. 1 , Cappa E. 2 , Dente D.2 , Brunocilla E. 1 , Dababneh H.1 , Chessa F.1 , Caffarelli A. 2 , Vagnoni V. 1 , Pultrone C.V. 1 , Giampaoli M. 1 , Martorana G.1 , Porreca A. 2 1 University
of Bologna-S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy, 2 Policlinic of Abano Terme, Dept. of Urology, Abano
Terme, Italy INTRODUCTION & OBJECTIVES: Barbed sutures are generally used during Robot-Assisted Radical Prostatectomy (RARP) for improving results of Urethro-Vesical Anastomosis (UVA); Posterior Muscolofascial Reconstruction (PMFR) help reducing the bleeding in the anastomotic area, increase the stability of the anastomosis and probably improving the early recovery of urinary continence. The aim of this study is to describe the technique of UVA and PMFR with a new single barbed bidirectional suture during RARP. MATERIAL & METHODS: From January 2012 to October 2015, 451 consecutive PCa patients, underwent RARP in two different urological centres. A 35-cm single 3/0 bi-directional barbed suture with two stitches (Fillbloc TM , Assut SPA) is used for PMFR and UVA. In the first step we suture the posterior layer of the Denonvilliers Fascia (DF) to the recto-urethral muscle with three passages of the two needles (two passage with the left stitch and one with the right one); the two ends of the sutures are gently pulled simultaneously. In the second step, the posterior edge of the bladder neck is sutured to the posterior edge of the urethra with the left end of the suture with two stitches from left to right; the step is completed with a third stitch using the right end of the suture. Then the longer suture is crossed from the right to the left side through the posterior plate of the anastomosis in order to block the sutures. In the third step, the UVA is completed with the left end of the suture starting clockwise from 7 to 12 o’clock and with the right end of the suture anticlockwise from 5 to 12 o’clock. All patients had complete perioperative and follow up data including the recovery of urinary continence (defined as no pad or 1 safety pad per day). RESULTS: The median (IQR) catheterization time and hospital stay were 4.1 (3-6) and 3.5 (3-8) days, respectively. The median (IQR) time of PMFR, UVA and overall technique was 3 min (2-5), 16 min (12-19) and 19 min (11-38) respectively. No intraoperative complications have been observed related to this phase of the RARP. Overall 5 patients (1%) experienced acute urinary retention, 4 (0.9%) had urinary leakage requiring catheterization and no stricture was recorded at 12 months of follow up. After the catheter removal, the recovery of the continence at 3 and 7 days was 60.5 and 75.8%, respectively, while the recovery of continence at 1, 3 and 12 months was 90.2, 97.6 and 98.4%. The median time to continence was 5.2 days. CONCLUSIONS: The technique of PMFR and UVA with the new single barbed suture is easy and reproducible with good results in terms postoperative complications. The single suture allows reproducing all the steps of PMFR and UVA of RARP in a very simple way and with short operative time, with good postoperative results.