With the advent of the laparoscopic prostatectomy, post-operative recovery is a hot issue. The minimal incision sometimes makes the anastomosis difficult because the needle driver cannot be handled effectively within the small operative exposure.

To manage the anastomosis suture more effectively, T. Miki and colleagues from Osaka Japan have employed the use of running suture using the Endostitch laparoscopic device and two braided absorbable sutures. Their experience with this technique in the minilap RRP is reported in the February 2006 issue of Urology.

In a series of 21 patients, a minilap RRP was performed and the vesicourethral anastomosis was handled in the following fashion. Two 2-0 Vicryl sutures were tied together at their tail ends. The bladder neck mucosa was everted and the anastomosis is created with two semicircular running sutures starting at 6 o'clock and running upwards- one clockwise and one counter-clockwise. A 20 F Foley catheter is placed prior to completion of the anastomosis then the suture is gently pulled and tied down

In the 21 cases in the series, it took between 12 and 20 minutes to perform the anastomosis. Five days after surgery, contrast cystography revealed no obvious leak in any of the patients. The urethral catheter was removed at 6 to 7 days after surgery. In outpatient follow-up of at least 3 months, satisfactory continence, defined as 0 (n=19) to 1 pad (n=2) was achieved in all patients in this study. The initial two patients complained of dysuria and were found to have bladder neck contractures that were treated with one dilation with a metal sound in the office. Since that time, the suture was tied down with less tension and no anastomotic strictures were found.

To fully judge the efficacy of this technique, more patients must be performed in this fashion. The initial issue with bladder neck contractures seems to be solved but long-term data should help to assess the true incidence of this complication.

Urology. 2006 Feb; 67(2):410-12

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