Arslan Murat, Tuncel Altug, Aslan Yilmaz, Kozacioglu Zafer, Gunlusoy Bulent, Atan Ali
Izmir University School of Medicine, Department of Urology, Izmir.
Arch Ital Urol Androl. 2014 Jun 30;86(2):90-4. doi: 10.4081/aiua.2014.2.90.
We compared polyglecaprone (Monocryl®) and bidirectional barbed (V-Loc® 180) running sutures during urethrovesial anastomosis (UVA) in laparoscopic radical prostatectomy (LRP).
A total of 92 consecutive patients underwent extraperitoneal LRP for prostate cancer. In the first 47 patients, the running UVA was performed using 3-0 monofilament polyglecaprone (Monocryl®) suture (Group 1). In the subsequent 45 patients, the running UVA was performed with the 3-0 barbed suture (V-Loc® 180) (Group 2). Rhabdosphincter reconstruction was performed in all the patients.
The mean prostatectomy time was 196 and 179 minutes in Group 1 and 2, respectively (p < 0.001). Moreover, the mean UVA time was 40 and 24 minutes in Group 1 and 2, respectively (p < 0.001). Also, catheterization time, lenght of hospital stay and the number of the patients with urine leakage were significantly lower in Group 2 than the other (p < 0.001). No patients in V-Loc® 180 suture group and 5 patients in Monocryl® suture group experienced postoperative drain leakage in the present study. Overall pad usage at 6th month was higher in group 1 than the other group. In group 1 and 2, 78.7% and 93.3% of the patients reported 0 to 1 pads daily, whereas 21.3% and 6.7% reported ≥ 2 pads daily (p = 0.002).
We therefore consider that use of barbed suture running UVA during LRP is associated with a significantly shorter operative time maintaining a proper suturing tension compared with standard suture and it is not associated with a higher incidence of adverse events with no postoperative complications.
我们在腹腔镜前列腺癌根治术(LRP)的尿道膀胱吻合术(UVA)过程中比较了聚乙醇酸(Monocryl®)和双向倒刺(V-Loc® 180)连续缝合线。
共有92例连续的前列腺癌患者接受了腹膜外LRP。前47例患者使用3-0单丝聚乙醇酸(Monocryl®)缝线进行连续UVA(第1组)。在随后的45例患者中,使用3-0倒刺缝线(V-Loc® 180)进行连续UVA(第2组)。所有患者均进行了横纹括约肌重建。
第1组和第2组的平均前列腺切除时间分别为196分钟和179分钟(p<0.001)。此外,第1组和第2组的平均UVA时间分别为40分钟和24分钟(p<0.001)。而且,第2组的导尿时间、住院时间和尿漏患者数量均显著低于另一组(p<0.001)。在本研究中,V-Loc® 180缝线组无患者发生术后引流管漏,而Monocryl®缝线组有5例患者发生。第1组第6个月时的总体尿垫使用量高于另一组。在第1组和第2组中,分别有78.7%和93.3%的患者报告每天使用0至1个尿垫,而分别有21.3%和6.7%的患者报告每天使用≥2个尿垫(p = 0.002)。
因此,我们认为在LRP期间使用倒刺缝线进行连续UVA与标准缝线相比,手术时间显著缩短,同时能保持适当的缝合张力,且与较高的不良事件发生率无关,无术后并发症。