Prospective randomized trial of barbed polyglyconate suture to facilitate vesico‐urethral anastomosis during robot‐assisted radical prostatectomy: time reduction and cost benefit
You can manage bookmarks using lists, please log in to your user account for this.
Media type:
E-Article
Title:
Prospective randomized trial of barbed polyglyconate suture to facilitate vesico‐urethral anastomosis during robot‐assisted radical prostatectomy: time reduction and cost benefit
Description:
<jats:sec><jats:label /><jats:p>Study Type – RCT (randomized trial)</jats:p><jats:p>Level of Evidence 2b</jats:p><jats:p><jats:bold>What's known on the subject? and What does the study add?</jats:bold></jats:p><jats:p>In a previous randomized controlled trial, barbed polyglyconate suture for vesico‐urethral anastomosis was associated with more frequent cystogram leaks, longer mean catheterization times and greater suture costs per case.</jats:p><jats:p>In the current randomized controlled trial, we show that barbed polyglyconate suture is associated with decreased anastomosis time, decreased need to readjust suture tension, cost reduction, and equal continence and early/late urinary complication rates.</jats:p></jats:sec><jats:sec><jats:title>OBJECTIVE</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>To examine the effectiveness of barbed polyglyconate suture (V‐Loc 180; Covidien, Mansfield, MA, USA) compared with standard monofilament for posterior reconstruction (PR) and vesico‐urethral anastomosis (VUA) during robot‐assisted radical prostatectomy (RARP).</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>A prospective randomized controlled trial was conducted in 70 consecutive RARP cases by a single surgeon (K.C.Z.).</jats:p></jats:list-item>
<jats:list-item><jats:p>Standard VUA was performed using three 4‐0 poliglecaprone 25 (Monocryl; Ethicon Endosurgery, Cincinnati, OH, USA) sutures secured with absorbable suture clips (LapraTy, Ethicon; one single 6‐inch [15.2 cm] for PR and two attached 6‐inch [15.2 cm] for VUA).</jats:p></jats:list-item>
<jats:list-item><jats:p>Barbed suture VUA was performed using two 3‐0 6‐inch (15.2 cm) barbed polyglyconate sutures.</jats:p></jats:list-item>
<jats:list-item><jats:p>Time to complete the suture set‐up by the nursing team, anastomosis time and need to adjust suture tension were recorded. Suture‐related complications, validated‐questionnaire continence and cost were also examined.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>Compared with a conventional reconstruction technique, there was a significant reduction in mean nurse set‐up time (31 vs. 294 s; <jats:italic>P</jats:italic> < 0.01) and reconstruction time (13.1 vs. 20.8 min; <jats:italic>P</jats:italic> < 0.01) for the barbed suture technique.</jats:p></jats:list-item>
<jats:list-item><jats:p>Need to readjust suture tension or to place additional suture clips for watertight closure was greater in the standard monofilament group than in the barbed suture group (6% vs. 24%; <jats:italic>P</jats:italic>= 0.03).</jats:p></jats:list-item>
<jats:list-item><jats:p>A cost reduction was recorded at our institution (48.05 vs. 70.25 $CAN) with the barbed suture technique.</jats:p></jats:list-item>
<jats:list-item><jats:p>With a mean follow‐up of 6.2 months, no delayed anastomotic leak or bladder neck contracture was observed in either group.</jats:p></jats:list-item>
<jats:list-item><jats:p>Pad‐free continence outcomes for the monofilament suture vs the barbed suture groups at 1 (64 vs. 69%, <jats:italic>P</jats:italic>= 0.6), 3 (76 vs. 81%, <jats:italic>P</jats:italic>= 0.5) and 6 months (88 vs. 92%, <jats:italic>P</jats:italic>= 0.7) were similar.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>Compared with standard monofilament suture, the unidirectional barbed polyglyconate suture appears to provide safe, efficient and cost‐effective PR and VUA during RARP.</jats:p></jats:list-item>
<jats:list-item><jats:p>Use of the interlocked barbed polyglyconate suture technique prevents slippage, precluding the need for assistance, knot‐tying and constant reassessment of anastomosis integrity.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec>