Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience.

Hemal, Ashok K; Agarwal, Mayank Mohan; Babbar, P

OBJECTIVE To evaluate impact of unidirectional barbed suture on vesicourethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP) and its comparison with Polyglecaprone-25 suture. PATIENTS AND METHODS The study was initiated as pilot study; the participants were grouped into three based on the suture material used for VUA, i.e., monofilament Polyglecaprone-25 (group 1), unidirectional barbed Glycolic acid-trimethylene carbonate (group 2), and bidirectional barbed Polyglycolic acid-polycaprolactone (group 3), respectively. Group 1 was included retrospectively and the latter two prospectively. All cases were operated upon by the same surgeon, proficient in RARP. Patient-demographics, intraoperative and peri-operative data were collected. Our technique of mucosa-to-mucosa VUA is carried out in a choreographed manner using unibarbed suture. RESULTS Fifty-five patients were included; 25 each in group 1 and 2. The group 3 was prematurely closed after 5 cases due to perceived inappropriateness of needle characteristics of the suture material. Therefore, the statistical analysis was performed between group 1 and 2 only. Preoperative characteristics including age, PSA, clinical stage, and biopsy grade were similar between the groups. The anastomosis time was significantly less in group 2 (8.4 ± 1.7 min vs. 14.3 ± 4.8 min; P = 0.0001; t test). Postoperative hospital stay was less in group 2 (2.7 ± 1.1 days vs. 1.9 ± 0.8 days; P = 0.023; Mann-Whitney U). None of the patient had presented with urinary leaks, urinary retention, or anastomotic strictures at follow-up of 6 months. CONCLUSION VUA with unidirectional barbed suture is safe and takes less time compared to monofilament suture as repeated cinching; help of assistance and knot tying are not required by virtue of its self-retaining characteristics.