Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Eur Urol. 2010 Dec;58(6):875-81. doi: 10.1016/j.eururo.2010.07.021. Epub 2010 Aug 2.
Transperitoneal robot-assisted laparoscopic prostatectomy (RALP) urethrovesical anastomosis is a critical step. Although the prevalence of urine leaks ranges from 4.5% to 7.5% at high-volume RALP centers, urine leaks prolong catheterization and may lead to ileus, peritonitis, and require intervention. Barbed polyglyconate sutures maintain running suture line tension and may be advantageous in RALP anastomosis for reducing this complication.
To compare barbed polyglyconate and polyglactin 910 (Vicryl, Ethicon, Somerville, NJ, USA) running sutures for RALP anastomosis.
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, randomized, controlled, single-surgeon study comparing RALP anastomosis using either barbed polyglyconate (n = 45) or polyglactin 910 (n = 36) sutures.
RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied.
Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured.
Although baseline characteristics and overall operative times were similar, barbed polyglyconate sutures were associated with shorter mean anastomosis times of 9.7 min versus 9.8 min (p = 0.014). In addition, anastomosis with barbed polyglyconate rather than polyglactin 910 sutures was associated with more frequent cystogram extravasation 8 d postoperatively (20.0% vs 2.8%; p = 0.019), longer mean catheterization times (11.1 d vs 8.3 d; p = 0.048), and greater suture costs per case ($51.52 vs $8.44; p < 0.001). After 8 of 29 (27.6%) barbed polyglyconate anastomosis sites demonstrated postoperative day 8 cystogram extravasation, we modified our technique to avoid overtightening, reducing cystogram extravasation to 1 (6.3%) of 16 subsequent barbed polyglyconate anastomosis sites. Potential limitations include small sample size and the single-surgeon study design.
Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.
经腹腔机器人辅助腹腔镜前列腺切除术（RALP）的尿道膀胱吻合是一个关键步骤。尽管在高容量 RALP 中心，尿漏的发生率在 4.5%至 7.5%之间，但尿漏会延长导管插入时间，并可能导致肠梗阻、腹膜炎，需要进行干预。带倒刺的聚甘醇酸缝线可维持连续缝线的张力，在 RALP 吻合术中可能有助于减少这种并发症。
比较带倒刺的聚甘醇酸缝线和聚乳酸 910（Vicryl，Ethicon，Somerville，NJ，USA）缝线在 RALP 吻合术中的应用。
设计、地点和参与者：这是一项前瞻性、随机、对照、单外科医生研究，比较了使用带倒刺的聚甘醇酸缝线（n=45）或聚乳酸 910 缝线（n=36）进行 RALP 吻合术。
研究了使用带倒刺的聚甘醇酸缝线或聚乳酸 910 缝线进行 RALP 吻合术。
测量手术时间、成本差异、围手术期并发症以及吻合缝线类型的膀胱造影剂外渗情况。
尽管基线特征和总手术时间相似，但带倒刺的聚甘醇酸缝线的平均吻合时间较短，为 9.7 分钟，而聚乳酸 910 缝线为 9.8 分钟（p=0.014）。此外，与聚乳酸 910 缝线相比，带倒刺的聚甘醇酸缝线吻合后更频繁地出现术后第 8 天膀胱造影剂外渗（20.0% vs 2.8%；p=0.019），平均留置导尿管时间更长（11.1 天 vs 8.3 天；p=0.048），每个病例的缝线成本更高（51.52 美元 vs 8.44 美元；p<0.001）。在 29 个带倒刺的聚甘醇酸吻合部位中的 8 个（27.6%）在术后第 8 天膀胱造影剂外渗后，我们修改了我们的技术以避免过度收紧，从而将膀胱造影剂外渗减少到随后的 16 个带倒刺的聚甘醇酸吻合部位中的 1 个（6.3%）。潜在的局限性包括样本量小和单外科医生研究设计。
与传统缝线相比，带倒刺的聚甘醇酸缝线成本更高，需要进行技术修改以避免过度收紧、延迟愈合，并延长 RALP 后的导尿管留置时间。
