Division of Urology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
J Endourol. 2012 Jun;26(6):711-5. doi: 10.1089/end.2011.0521. Epub 2012 Feb 10.
One of the more challenging portions of robot-assisted radical prostatectomy (RARP) is the urethrovesical anastomosis. Because of this, a unidirectional absorbable barbed suture (V-Loc(™)) has been used to complete the anastomosis with better efficiency and less tension. The effect of robotic needle driver manipulation on barbed suture is unknown. Therefore, the aim of this study is to determine whether robotic manipulation decreases the tensile strength and peak sliding force of V-Loc barbed suture.
Fifty-six V-Loc sutures were compared with 56 Maxon sutures. All sutures were 3-0 caliber. Half of the sutures in each group were manipulated with a da Vinci(®) robot large needle driver five times over a 5 cm length of suture. The other half was not manipulated. Breaking force was determined by placing sutures in a Bose ElectroForce load testing device. For sliding force testing, 28 V-Loc sutures were manipulated in the same fashion and compared with 28 nonmanipulated V-Loc sutures. Peak force needed to make the suture slip backward in porcine small intestine was determined to be the sliding force. Scanning electron microscopy of the barbs before and after robotic manipulation was also performed.
The mean difference in breaking forces for manipulated vs nonmanipulated Maxon sutures was 4.52 N (P=0.004). The mean difference in breaking forces for manipulated vs nonmanipulated V-Loc sutures was 1.30 N (P=0.046). The manipulated V-Loc group demonstrated a lower peak sliding force compared with the nonmanipulated group (0.76 vs 0.88 N, P=0.199). Electron microscopy revealed minor structural damage to the barbs and suture.
Tensile strength and peak sliding force of V-Loc suture is decreased by robotic manipulation. This is likely because of structural damage to the suture and barbs. This structural damage, however, is likely not clinically significant.
机器人辅助根治性前列腺切除术（RARP）中较具挑战性的部分之一是尿道膀胱吻合术。正因为如此，单向可吸收带刺缝线（V-Loc（™））已被用于完成吻合术，以提高效率并减少张力。机器人缝合器操作对带刺缝线的影响尚不清楚。因此，本研究旨在确定机器人操作是否会降低 V-Loc 带刺缝线的拉伸强度和峰值滑动力。
比较了 56 根 V-Loc 缝线和 56 根 Maxon 缝线。所有缝线均为 3-0 号。每组缝线的一半用达芬奇（®）机器人大缝合器操作 5 次，缝线长度为 5cm。另一半未操作。通过将缝线放置在 Bose ElectroForce 负载测试设备中确定断裂力。为了进行滑动力测试，以相同方式操作 28 根 V-Loc 缝线，并与 28 根未操作的 V-Loc 缝线进行比较。确定使缝线向后滑动穿过猪小肠所需的峰值力即为滑动力。还对机器人操作前后的刺进行了扫描电子显微镜检查。
与未操作的 Maxon 缝线相比，操作后的 Maxon 缝线的平均断裂力差异为 4.52N（P=0.004）。与未操作的 V-Loc 缝线相比，操作后的 V-Loc 缝线的平均断裂力差异为 1.30N（P=0.046）。与未操作的 V-Loc 组相比，操作后的 V-Loc 组的峰值滑动力较低（0.76 与 0.88N，P=0.199）。电子显微镜显示刺和缝线的结构略有损坏。
V-Loc 缝线的拉伸强度和峰值滑动力因机器人操作而降低。这可能是由于缝线和刺的结构损坏所致。然而，这种结构损坏可能在临床上并不重要。
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