Open AccessV-Loc urethro-intestinal anastomosis during robotic cystectomy with orthotopic urinary diversion
Author(s) -
Khanh Pham,
Bryan S. Sack,
R Corey O'Connor,
Michael L. Guralnick,
Peter Langenstroer,
William A. See,
Kenneth Jacobsohn
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.508
Subject(s) - urinary diversion , cystectomy , anastomosis , medicine , surgery , fibrous joint , urinary system , leak , barbed suture , bladder cancer , urology , cancer , environmental engineering , engineering
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.