Modified Running Vesicourethral Anastomosis Following Robotically-Assisted Laparoscopic Radical Prostatectomy: Use of Solitary Lapra-Ty to Secure Posterior Approximation

Adam J. Ball, Kevin P. Bordeau, John W. Davis, Robert W. Given, Donald F. Lynch, Scott G. Hubosky*, Michael D. Fabrizio
Devine-Tidewater Urology, Norfolk, VA

Introduction: We describe a novel method of ensuring posterior approximation and preventing urinary leak during the running anastomosis of a robotically-assisted laparoscopic prostatectomy (RaLP).
Methods: Two 3-0 Monocryl RB-1 sutures are tied end-to-end (an undyed suture at 9 inches and a dyed suture at 7 inches in length). The undyed suture is placed first at the 5 o’clock position on the bladder side outside-in and then through the urethra at the same location inside-out. Proceeding clockwise, the suture is placed twice more through both the bladder and the urethra. With gentle manipulation, the suture is cinched down to provide secure posterior approximation; however, if tension is released from suture coming from the urethra, the approximation may loosen and could result in a potential “gap” and site for anastomotic leakage. To prevent potential loosening, tension is maintained on the stitch as a single Lapra-Ty is placed at the base of the suture as it leaves the urethra. When tension is released, the posterior approximation is tightly maintained and the remaining anastomosis is completed.
Results: We have performed 115 RaLPs. Six urinary leaks requiring prolonged catheterization were identified in our first 90 patients (6.7%). We have not experienced any urinary leakage or short-term complications in the subsequent 15 patients using this technique.
Conclusions: A novel technique is described to ensure secure posterior approximation during the vesicourethral anastomosis following a RaLP. A single Lapra-Ty placed early during the anastomosis prevents potential “gaps” in the approximation which may be the source of troublesome leakage.

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