1] Numerous modifications have also been described to facilitate VUA, prevent anastomotic leaks and improve continence outcomes.
12] Since the initial porcine study by Weld and colleagues, which assessed self-anchoring suture (SAS) material for urinary tract reconstruction, two recent publications have emerged assessing barbed suture for RARP VUA demonstrating feasibility and increased efficiency.
Urinary reconstruction was carried out with the V-Loc180 barbed suture for both PR and VUA.
3,8,15] After radical prostatectomy specimens were collected in an Endo Catch bag (Covidien, Norwalk, CT), the posterior reconstruction and VUA were performed.
Once the PR was complete, the same left arm of the interlocked suture began the VUA starting with a 6-o'clock, out-side-in, transmural bite of the bladder followed by an inside-out bite of the posterior urethra.
Intraoperative adverse events (shearing of urethra or bladder neck, need for revision of VUA tension or placement of additional sutures) and postoperative complications (development of postoperative retention following catheter removal on postoperative day 4 to 5, urinoma formation and anastomotic strictures) were recorded.
All VUA reconstructions were completely by the console surgeon independently, without any laparoscopic aid from the bed-side assistant.
Particular to the VUA, surgeons in their early learning experience may only get to this step after several hours on the console, by which time they may be fatigued and result in suboptimal closure.
In their initial experience, VUA times ranged from 14 to 80 minutes.
Martin Slade, Managing Director of VUA
, commented: "This transaction provides our employees, clients and broking contacts with the certainty and security that comes with being part of a major U.