Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: Technique and outcomes

Stephen Williams, Mehrdad Alemozaffar, Yin Lei, Nathanael Hevelone, Stuart R. Lipsitz, Blakely A. Plaster, Jim C. Hu

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: 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. Objective: 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. Surgical procedure: RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied. Measurements: Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured. Results and limitations: 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. Conclusions: Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.

Original languageEnglish (US)
Pages (from-to)875-881
Number of pages7
JournalEuropean Urology
Volume58
Issue number6
DOIs
StatePublished - Dec 2010
Externally publishedYes

Fingerprint

Polyglactin 910
Prostatectomy
Sutures
Randomized Controlled Trials
Catheterization
Operative Time
polyglyconate
Urine
Costs and Cost Analysis
Ileus
Peritonitis
Sample Size

Keywords

  • Anastomosis
  • Complications
  • Continence
  • Quill
  • Radical prostatectomy
  • Robotic
  • Suture
  • Urine leak

ASJC Scopus subject areas

  • Urology

Cite this

Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis : Technique and outcomes. / Williams, Stephen; Alemozaffar, Mehrdad; Lei, Yin; Hevelone, Nathanael; Lipsitz, Stuart R.; Plaster, Blakely A.; Hu, Jim C.

In: European Urology, Vol. 58, No. 6, 12.2010, p. 875-881.

Research output: Contribution to journalArticle

Williams, Stephen ; Alemozaffar, Mehrdad ; Lei, Yin ; Hevelone, Nathanael ; Lipsitz, Stuart R. ; Plaster, Blakely A. ; Hu, Jim C. / Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis : Technique and outcomes. In: European Urology. 2010 ; Vol. 58, No. 6. pp. 875-881.
@article{ce692d694da4472788689ff136a9ef42,
title = "Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: Technique and outcomes",
abstract = "Background: 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. Objective: 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. Surgical procedure: RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied. Measurements: Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured. Results and limitations: 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. Conclusions: Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.",
keywords = "Anastomosis, Complications, Continence, Quill, Radical prostatectomy, Robotic, Suture, Urine leak",
author = "Stephen Williams and Mehrdad Alemozaffar and Yin Lei and Nathanael Hevelone and Lipsitz, {Stuart R.} and Plaster, {Blakely A.} and Hu, {Jim C.}",
year = "2010",
month = "12",
doi = "10.1016/j.eururo.2010.07.021",
language = "English (US)",
volume = "58",
pages = "875--881",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis

T2 - Technique and outcomes

AU - Williams, Stephen

AU - Alemozaffar, Mehrdad

AU - Lei, Yin

AU - Hevelone, Nathanael

AU - Lipsitz, Stuart R.

AU - Plaster, Blakely A.

AU - Hu, Jim C.

PY - 2010/12

Y1 - 2010/12

N2 - Background: 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. Objective: 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. Surgical procedure: RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied. Measurements: Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured. Results and limitations: 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. Conclusions: Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.

AB - Background: 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. Objective: 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. Surgical procedure: RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied. Measurements: Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured. Results and limitations: 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. Conclusions: Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.

KW - Anastomosis

KW - Complications

KW - Continence

KW - Quill

KW - Radical prostatectomy

KW - Robotic

KW - Suture

KW - Urine leak

UR - http://www.scopus.com/inward/record.url?scp=78049468996&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049468996&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2010.07.021

DO - 10.1016/j.eururo.2010.07.021

M3 - Article

C2 - 20708331

AN - SCOPUS:78049468996

VL - 58

SP - 875

EP - 881

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -