ENDOUROLOGY & LAPAROSCOPY

Technique for laparoscopic running urethrovesical anastomosis: the single knot method
Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV
Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; and Department of Urology, University of California Irvine, Orange, California, USA
Urology 2003; 61: 699-702

• Objectives: To describe a technique for facilitating the urethrovesical anastomosis at the time of laparoscopic radical prostatectomy.
• Methods: Two 6-in. polyglycolic acid sutures (one dyed, one white) are tied together at their tail ends and delivered into the operative field by way of a 12-mm port. A running suture is completed from the 6:30 to the 12:00-o’clock position and from the 5:30 to the 12:00-o’clock position, at the end of which a single intracorporeal tie is completed. The catheter is placed before completing the anterior row of sutures; the catheter is left in place for 5 to 7 days.
• Results: This anastomotic technique has been used in 122 laparoscopic radical prostatectomies and 8 robot-assisted laparoscopic radical prostatectomies. The average time for the anastomosis was 35 minutes (range 14 to 80). All anastomoses were watertight. No symptomatic postoperative urinary leaks have occurred, and no clinically evident clinical bladder neck contractures resulted.
• Conclusions: We describe a simple, watertight, running laparoscopic suture technique for accomplishing the urethrovesical anastomosis during laparoscopic radical prostatectomy.
  
• Editorial Comment
  This really is a wonderful suturing technique, which I was fortunate enough to learn about directly from the authors while visiting the University of California Irvine. Although I have not found it useful for laparoscopic pyeloplasties (I use the Endostich device with a non-robotic laparoscopic technique), the 2 of us at our institution performing robotic-assisted laparoscopic radical prostatectomies have used it with great satisfaction for the urethrovesical anastomosis. The authors’ current modification of the technique described in this article (accepted in December 2002) includes using a monofilament suture for one arm and a braided suture for the other. The braided suture is first placed for 2 throws (outside-in on bladder neck, then inside-out on the urethra) and then the monofilament suture is placed for 5 throws (first 2 as for the braided suture, then 3 more throws). At this point 20- 25% of the anastomosis is complete and the bladder is pulled down to the urethra with gentle traction. The monofilament slides easily. Traction on the monofilament suture by the assistant keeps the anastomosis opposed as a few more throws are placed with the braided suture. Friction from the braided suture now keeps the anastomosis together without additional assistance and the remainder can be completed rapidly. This technique markedly simplifies the laparoscopic urethrovesical anastomosis. Our experience to date (albeit with short follow-up) is similar to that of the authors with no “clinically evident post-operative urinary leak or symptomatic bladder neck contractures.”

Dr. J. Stuart Wolf Jr.
Associate Professor of Urology
University of Michigan
Ann Arbor, Michigan, USA