“Robotic-assisted laparoscopic extravesical ureteral reimplantation: An initial experience.”
Chalmers, D., K. Herbst, et al. (2011).
Journal of Pediatric Urology.
Objective: There are many emerging techniques using robotic-assisted laparoscopy (RAL) in pediatrics. We performed a retrospective review of our first patients who underwent RAL extravesical ureteral reimplantation. Materials/Methods: Between October 2007 and May 2010, a single surgeon performed RAL extravesical ureteral reimplantation in 17 patients. Six patients underwent bilateral reimplantation, resulting in a total of 23 ureters repaired. There were 16 females and 1 male (mean age 6.23 years). Four patients had prior Deflux injection. Postoperative reflux status was assessed by voiding cystourethrogram. Results: 16 patients (22 ureters) were compliant with follow up. Mean follow up was 11.5 months. Mean anesthetic time was 3 h, 57 min for unilateral and 4 h, 45 min for bilateral repair. Complete vesicoureteral reflux resolution was seen in 20 ureters (90.9%), downgrading in one ureter, and unchanged persistent reflux in one ureter. Average hospital stay was 1.3 days. No patients required postoperative catheterization at discharge. Conclusions: Outcomes for new procedures can be variable and unpredictable as the technique evolves. Given the high success rates of open reimplantation, a minimally invasive technique must show comparable results if it is to play a continuing role. Our initial results are encouraging, but prospective analyses are required to outline the future role of RAL ureteral reimplantation. © 2011 Journal of Pediatric Urology Company.
“Early experience in robotic-assisted laparoscopic bilateral intravesical ureteral reimplantation for vesicoureteral reflux in children.”
Chan, K. W. E., K. H. Lee, et al. (2011).
Journal of Robotic Surgery: 1-4.
A high success rate has been reported for laparoscopic intravesical ureteral reimplantation in the management of high-grade vesicoureteral reflux in children. With the introduction of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA), robotic-assisted laparoscopic intravesical ureteral reimplantation may provide additional benefits, particularly in intravesical suturing. We present here our experience in three children, all with high-grade bilateral vesicoureteral reflux, who underwent robotic-assisted laparoscopic intravesical bilateral ureteral reimplantation. The procedure was successfully performed in all cases. There were no intra-operative or post-operative complications. Operative times were 430, 240 and 220 min. Hospital stay was 7, 6 and 2 days. Postoperative voiding cystourethrogram confirmed resolution of vesicoureteral refluxes in all cases and all three children were free from urinary tract infections on follow-up. Our initial experience with robotic-assisted laparoscopic intravesical ureteral reimplantation has shown this to be a technically safe and feasible option in the management of children with bilateral high-grade vesicoureteric reflux. © 2011 Springer-Verlag London Ltd.
“Retroperitoneal robotic-assisted laparoscopic reimplantation of a ureter into an ileal conduit.”
Durbin, J. M., J. Bejma, et al. (2011).
Journal of Robotic Surgery: 1-3.
A novel technique for managing ureteroenteric strictures is robotic-assisted retroperitoneal laparoscopic reimplantation. A 63-year-old morbidly obese male underwent a left nephroureterectomy and cystoprostatectomy after neoadjuvant chemotherapy for transitional cell carcinoma of both the bladder and left kidney. His single right ureter was anastomosed to the ileal conduit. Postoperatively, he developed acute renal failure and hydronephrosis. An antegrade pyelogram demonstrated a distal stricture that failed two attempts at endoscopic management. In an effort to avoid the morbidity of an open repair, we present a minimally invasive option that replicates the steps of an open reimplantation. © 2011 Springer-Verlag London Ltd.
“Robotic extended pelvic lymphadenectomy for bladder cancer with increased nodal yield.”
Lavery, H. J., H. J. Martinez-Suarez, et al. (2011).
BJU International 107(11): 1802-1805.
Objective To report our initial experience with robot-assisted extended pelvic lymph node dissection (ePLND) using a standardized open template. Patients and Methods In total, 15 consecutive patients underwent robotic radical cystectomy at a single center by a single surgeon using a standard dissection template. Operating time, time to perform ePLND, pathological stage, estimated blood loss, length of hospital stay, number of nodes obtained and nodal positivity were assessed. Postoperative complications and re-admissions were reviewed. Results The mean (range) age and body mass index was 66 (46-87) years and 29 (22-43) kg/m2, respectively. The mean (range) operating time and ePLND time was 423 (300-506) min and 107 (66-160) min. Mean (range) estimated blood loss was 160 (50-500) mL. The mean (range) and median length of hospital stay were 3.4 (3-7) days and 3 days, respectively. The mean (range) nodal yield was 41.8 (18-67) nodes, with greater than 25 nodes in 13 patients. Three patients were found to have nodal positivity. Of the fifteen patients, four received neoadjuvant chemotherapy. Two patients were re-admitted for postoperative complications within 30 days. There were no complications directly resulting from the ePLND. Conclusions Robot-assisted ePLND at the time of cystectomy can be safely and effectively performed on the robotic platform with comparable nodal yields to open series at centers of excellence for cystectomy. Nodal yields are likely to comprise a factor related to the effort of the surgeon, and not the method by which the lymphadenectomy is performed. © 2010 BJU INTERNATIONAL.
“Robot-assisted laparoscopic reconstruction of retrocaval ureter: Description and video of technique.” Leroy, T. J., D. D. Thiel, et al. (2011).
Journal of Laparoendoscopic and Advanced Surgical Techniques 21(4): 349-351.
Ureteral obstruction secondary to retrocaval ureter is rarely reported in the urologic literature. Symptomatic retrocaval ureters usually present in the 3rd and 4th decade of life. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robot-assisted laparoscopic repair of a retrocaval ureter. © Copyright 2011, Mary Ann Liebert, Inc.
“Ileovesicostomy for the neurogenic bladder patient: Outcome and cost comparison of open and robotic assisted techniques.”
Vanni, A. J. and J. T. Stoffel (2011).
Urology 77(6): 1375-1380.
Objectives: To compare the outcomes and cost of open and robotic-assisted ileovesicostomy techniques for the adult neurogenic bladder patient. Methods: Consecutive open and robotic-assisted ileovesicostomy procedures were retrospectively reviewed for demographic, operative, and postoperative recovery data. Surgical outcome was assessed by examining the incidence of postprocedure urinary incontinence, urinary tract infections (UTIs), and upper tract compromise. Total cost was calculated through summation of inpatient costs, including room/board, operating/recovery room, surgical supplies, professional fees, intensive care unit, and robotic maintenance. Results: Fifteen ileovesicostomy procedures (7 open, 8 robotic) were reviewed. Both groups had similar demographic and urodynamic data. Operative times (293 min open vs 330 min robotic, P = .24) were similar between techniques. There were trends toward lower operative blood loss (100 mL vs 257 mL, P = .09) and shorter hospital stays in the robotic group (8 days vs 11 days, P = .14). Ileovesicostomy was associated with improved urinary continence (P = .02) and trended toward a decreased incidence of postoperative chronic UTI (P = .13) for the entire group, and there was no difference between techniques regarding continence, chronic UTIs, and complications. No patients in either group developed postoperative hydronephrosis. Total inpatient cost for the open and robotic groups was $14,356 and $17,344 (P = .05), which differed primarily because of higher robotic operating room supply costs ($609 vs $3770, P <.001). Conclusion: Robotic and open ileovesicostomy had similar surgical outcomes in this patient cohort, although total inpatient costs were significantly higher in the robotic group. © 2011 Elsevier Inc.
“Closing the deal: renorrhaphy during laparoscopic and robotic partial nephrectomy.”
Ghani, K. R. and C. Anderson (2011).
BJU International 108(1): 2-4.
“Robotic-assisted Nephroureterectomy and Bladder Cuff Excision Without Intraoperative Repositioning.”
Hemal, A. K., I. Stansel, et al. (2011).
Objective: To present surgical tips and describe a novel technique for successful performance of robotic nephroureterectomy with bladder cuff excision (RNUBCE). We report a technique of RNUBCE without intraoperative patient repositioning or redocking of the robot. Materials and Methods: Nephroureterectomy with bladder cuff excision is the standard management of high-grade or bulky upper tract transitional cell carcinoma. Lymphadenectomy is performed when clinically indicated. Fifteen patients underwent RNUBCE between January 2009 and May 2010. Several key points to this operation contribute to its success. Ports are strategically placed to allow access to the kidney, ureter, and bladder. The ureter is clipped, though not divided, immediately after ligating the renal hilum to minimize the risk of tumor seeding resulting from manipulation of the kidney. In cases of ureteric tumors, wide dissection of the ureter is carried out to avoid a positive margin or entry into the ureter. Bladder stay sutures are placed lateral to the ureterovesical junction to prevent retraction of the bladder once the bladder cuff is excised. If desired, a partial excision of the cuff can be performed with the ureter acting as a bucket handle. Results: All procedures were performed successfully without complications. Mean total operative time was 184 minutes, estimated blood loss was 103 mL, and mean hospital stay was 2.7 days. Short-term oncological outcomes have revealed no recurrences. Conclusions: RNUBCE, with lymphadenectomy when clinically indicated, provides a viable treatment option for patients with upper tract transitional cell carcinoma. © 2011 Elsevier Inc. All rights reserved.
“Open Versus Robot-Assisted Partial Nephrectomy: Effect on Clinical Outcome.”
Lee, S., J. Oh, et al. (2011).
Journal of Endourology.
Abstract Background and Purpose: Robot-assisted partial nephrectomy (RPN) has emerged as a viable alternative to open partial nephrectomy (OPN) for small renal masses (SRMs). Comparative outcomes of RPN and OPN at a single institution were analyzed. Patients and Methods: A retrospective review was performed to compare 69 RPNs with 234 OPNs between May 2003 and December 2010 at a single institution. Clinicopathologic variables, operative parameters, and renal functional outcomes were analyzed. Results: There were no significant differences between the two cohorts (RPN vs OPN) with respect to patient age (P=0.609), sex (P=0.703), preoperative estimated glomerular filtration rate (eGFR, P=0.146), estimated blood loss (P=0.600), and tumor size (P=0.256). The mean operative time was longer in the RPN group (192 vs 142 min, P<0.001). The mean warm ischemia time was longer in the RPN cohort (22.99 vs 18.87 min, P<0.001), but there were no significant differences in the postoperative eGFR (P=0.162) and change in the eGFR (P=0.520). The length of hospitalization (6.2 vs 8.9 d, P<0.001) and use of postoperative analgesics (ketoprofen, 0.26 vs 0.88 ampules, P<0.001) were more favorable in the RPN cohort. The number of patients with positive surgical margins was 0 for the RPN and 6 for the OPN groups. The intraoperative complication rates were 4.35% and 4.27% in the RPN and OPN groups, respectively (P=0.999). The overall postoperative complication rates were 8.7% and 15.4% in the RPN and OPN groups, respectively (P=0.158). Conclusions: RPN is a viable option as a nephron-sparing surgical procedure for SRMs considering the perioperative parameters and postoperative renal function changes, in addition to the traditional benefits of the laparoscopic procedure.
“Complications After Robotic Partial Nephrectomy at Centers of Excellence: Multi-Institutional Analysis of 450 Cases.”
Spana, G., G. P. Haber, et al. (2011).
Journal of Urology.
Purpose: We evaluated the incidence of perioperative complications after robotic partial nephrectomy. Materials and Methods: We retrospectively reviewed the records of patients treated with robotic assisted partial nephrectomy across the 4 participating institutions. Demographic, blood loss, warm ischemia time, and intraoperative and postoperative complication data were collected. All complications were graded according to the Clavien classification system. Results: A total of 450 consecutive robotic assisted partial nephrectomies were done between June 2006 and May 2009. Overall 71 patients (15.8%) had a complication, including intraoperative and postoperative complications in 8 (1.8%) and 65 (14.4%), respectively. Hemorrhage developed in 2 patients (0.2%) intraoperatively and in 22 (4.9%) postoperatively. Seven patients (1.6%) had urine leakage. As classified by the Clavien system, complications were grade I-II in 76.1% of cases and grade III-IV in 23.9%. Robotic assisted partial nephrectomy was converted to open or conventional laparoscopic surgery in 3 patients (0.7%) and to radical nephrectomy in 7 (1.6%). There were no deaths. Conclusions: Current data indicate that robotic assisted partial nephrectomy is safe. Most postoperative complications are Clavien grade I or II, or can be managed conservatively. © 2011 American Urological Association Education and Research, Inc.
“Robot-assisted partial nephrectomy: analysis of the first 100 cases from a single institution.”
Tobis, S., S. Venigalla, et al. (2011).
Journal of Robotic Surgery: 1-9.
Robot-assisted partial nephrectomy (RAPN) is an alternative to open and laparoscopic partial nephrectomy for small renal tumors. Our objectives were to report our experience and short-term outcomes from the first 100 cases of robot-assisted partial nephrectomy (RAPN) performed at a single institution, as well as to evaluate the effect of the learning curve and identify any factors associated with adverse perioperative outcomes. Patient records of the first 100 RAPN cases performed by three surgeons between October 2007 and March 2010 were retrospectively reviewed. The cases were divided into two groups to analyze a possible learning curve effect. Group 1 consisted of the first half (chronologically) of the cases performed by each surgeon, and Group 2 consisted of the second half. For the entire series, the median warm ischemia time was 24 min (range 11-49), mean length of follow-up was 13.4 months, and the median postoperative change in glomerular filtration rate (GFR) was -6.6 mL/min/1.73 m2. Three patients had microscopically positive margins on final pathology, three intraoperative complications occurred, and 13 postoperative complications were recorded (10 Clavien grade IIIa or less). Median operative time was significantly longer in Group 1 (193 min) than in Group 2 (165 min, P = 0.003). Multivariate analysis identified male gender and cases done in Group 1 to be associated with increased operative time, while male gender and higher nephrometry scores were associated with increased blood loss. Tumor characteristics associated with greater reductions in GFR included higher nephrometry scores, endophytic tumors, and hilar tumors. In conclusion, RAPN appears to be safe and the major effect of the learning curve appears to be on operative time. Warm ischemia times are sufficiently low to prevent significant renal impairment, while male gender and higher nephrometry scores may be predictors of longer operative times and more intraoperative blood loss. Overall operative time decreased with increasing case volume, although this was not uniform among the three surgeons in the study. Further longitudinal study is necessary to establish oncologic outcomes. © 2011 Springer-Verlag London Ltd.
“External validation of a model for tailoring the operative approach to minimally invasive partial nephrectomy.”
Vricella, G. J., S. Murray, et al. (2011).
BJU International 107(11): 1806-1810.
Objective To externally validate and modify an existing technical strategy of prospectively tailoring one’s operative approach to minimally invasive partial nephrectomy (MIPN). Patients and Methods We prospectively applied the model used in this strategy to evaluate 44 consecutive patients who underwent MIPN between August 2006 and August 2008. Patients were divided into four groups according to tumour depth of penetration or entry into the collecting system. Group 1 (n= 9, 20%) underwent MIPN without clamping the renal hilum or parenchymal suturing. Group 2 (n= 2, 5%) underwent clamping but not suturing. Group 3 (n= 21, 48%) underwent clamping and suturing. Group 4 (n= 12, 27%) underwent clamping, renal sinus reconstruction and suturing. We then assessed the peri- and postoperative outcomes, tumour histopathology and complications for each group. Results All patients had successful procedures according to the strategic model. The mean operative time was 246 (105-420) min and the mean estimated blood loss was 177 (25-1000) mL. When patients were stratified by clamping vs no clamping, the only significant variables between the two groups were operative time (245 vs 203 min) and pathology (83% vs 44% malignant). Six patients in the clamping group had postoperative complications (three had delayed bleeding, two had pneumonia, and one had infected urinoma) vs one patient in the no-clamping group who had prolonged ileus (P > 0.05). Mean hospital stay was comparable in both groups (2.6 vs 3 days). Conclusion Minimally invasive partial nephrectomy can be tailored according to tumour location, avoiding unnecessary clamping and/or suturing of the kidney without negatively affecting treatment outcomes. © 2010 BJU INTERNATIONAL.
“Feasibility and Adequacy of Robot-Assisted Lymphadenectomy for Renal-Cell Carcinoma.”
Abaza, R. and G. Lowe (2011).
Journal of Endourology.
Abstract Background and Purpose: The role of lymph node dissection (LND) for renal-cell carcinoma (RCC) is evolving. When clinically negative, nodal disease is rare, but LND remains important in selected patients. Earlier identification of micrometastasis may become beneficial with emerging systemic agents. The ability to perform an adequate LND laparoscopically is uncertain. Open surgical data suggest a minimum of 12 nodes needed to identify most nodal metastases. Robotics may improve adequacy of laparoscopic LND. We report our results with the first reported robot-assisted LND series for RCC. Patients and Methods: Robot-assisted LND was performed in 36 patients with RCC by a single surgeon. For right-sided tumors, LND included paracaval, retrocaval, and interaortocaval nodes, and left-sided tumors included interaortocaval and periaortic nodes. Results: Mean patient age was 58 years (22-79) with a mean body mass index of 32 kg/m(2) (20-54). Mean tumor size was 7.3 cm with 16 T(3) tumors, including 4 vena caval tumor thrombi. Mean time for LND was 31 minutes, and mean estimated blood loss was 74 mL with no transfusions. Discharge was postoperative day (POD) 1 in 94% and POD 2 in 6%. A mean of 13.9 nodes was obtained with 1 pN+ (2.8%) patient. Mean nodal yield from the first to second half of cases rose from 11 to 16.8 nodes (P=0.02) with 77% having a minimum of 12 nodes in the second half. Conclusions: Robot-assisted LND for RCC is feasible with adequate nodal yield. Increased yield in later cases may reflect a learning curve. The positivity rate was low as expected, but higher yield was obtained than in the limited laparoscopic literature.
“Mentorship programmes for laparoscopic and robotic urology.”
Abboudi, M., K. Ahmed, et al. (2011).
BJU International 107(12): 1869-1871.
“Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments.”
Casciola, L., A. Patriti, et al. (2011).
Surgical Endoscopy: 1-10.
Objective: The aim of the study is to describe techniques of robot-assisted parenchymal-sparing liver surgery. Background: Laparoscopy provides the same oncologic outcomes as open liver resection and better early outcome. Limitations of laparoscopy remain resections in posterior and superior liver segments, frequently approached with laparoscopic right hepatectomy, bleeding from the section line, and prolonged operative times when a combined procedure is needed. Methods: We retrospectively analyzed our series of robot-assisted liver resections between 2008 and September 2010 to evaluate whether robot assistance can overcome the limitations of laparoscopy. Results: A total of 23 patients underwent robot-assisted liver resection for a total of 21 subsegmentectomies, 6 segmentectomies, 2 segmentectomies S6 + subsegmentectomies S7, 1 bisegmentectomy S2-3, and 2 pericystectomies. In ten cases (47.8%) liver nodules were located in the posterior and superior liver segments. In three cases the tumor was in contact with a main portal branch and in two cases with a hepatic vein. In one case the tumor had contact with both hepatic vein and portal branch. In the latter cases a no-margin resection was carried out. In 16 cases (65.5%) liver resection was associated with a concomitant procedure (10 laparoscopic colectomies, 1 robotic rectal resection, 3 laparoscopic radiofrequency ablations, and 2 extensive adhesiolyses). Mean operative time was 280 ± 101 min, blood loss was 245 ± 254 ml, and mean hospital stay was 8.9 ± 9.4 days. Mortality was nil. One case of biliary leakage and two of intraoperative hemorrhage requiring transfusion were the main complications encountered. Conclusions: Robot assistance allows optimal access to all liver segments and facilitates parenchymal-sparing surgery also for lesions located in the posterosuperior segments or in contact with main liver vessels. © 2011 Springer Science+Business Media, LLC.
“Current technology in navigation and robotics for liver tumours ablation.”
Chang, S. K., W. W. Hlaing, et al. (2011).
Annals of the Academy of Medicine, Singapore 40(5): 231-236.
Radiofrequecy ablation is the most widely used local ablative therapy for both primary and metastatic liver tumours. However, it has limited application in the treatment of large tumours (tumours >3cm) and multicentric tumours. In recent years, many strategies have been developed to extend the application of radiofrequency ablation to large tumours. A promising approach is to take advantage of the rapid advancement in imaging and robotic technologies to construct an integrated surgical navigation and medical robotic system. This paper presents a review of existing surgical navigation methods and medical robots. We also introduce our current developed model – Transcutaneous Robot-assisted Ablation-device Insertion Navigation System (TRAINS). The clinical viability of this prototyped integrated navigation and robotic system for large and multicentric tumors is demonstrated using animal experiments.
“Robotic right hepatectomy for giant hemangioma in a Jehovah’s Witness.”
Giulianotti, P. C., P. Addeo, et al. (2011).
Journal of Hepato-Biliary-Pancreatic Sciences 18(1): 112-118.
The use of minimally invasive surgery for the resection of benign liver tumors has increased in recent years as results show decreased abdominal damage and significant cosmetic advantages. Herein, we describe the first reported application of minimally invasive surgery for the removal of a giant symptomatic hemangioma, using robotic surgery, in a Jehovah’s Witness (JW) patient. A 32-year-old JW presented with abdominal discomfort and recent episodes of acute abdominal pain due to a giant cavernous hemangioma involving segments VI and VII of the liver. Because of the location and size of the lesion, a right hepatectomy was planned. After a careful preoperative evaluation, a robotic right hepatectomy was performed using the da Vinci Surgical System. The procedure was successfully completed in minimally invasive fashion with an operative time of 310 min and with an intraoperative blood loss of only 300 ml. The postoperative course was uneventful and the patient was discharged on postoperative day 10. At 30-month follow up the patient reported complete relief of symptoms and good esthetic results. In experienced hands, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal blood loss in a JW patient. A careful preoperative and intraoperative strategy is required and significant experience in liver and robotic surgery is mandatory.
“[Junior ERUS : Robot-assisted urology: from bedside surgeon to console surgeon.].”
Porres, D. (2011).
Urologe. Ausgabe A.
“Consumerism and its impact on robotic-assisted radical prostatectomy.”
Alkhateeb, S. and N. Lawrentschuk (2011).
Study Type – Therapy (prevalence) Level of Evidence 2b OBJECTIVES: * Many experts consider that media coverage, marketing and/or direct-to-consumer advertising, particularly Internet-based forms, are fundamental to the widespread adoption of robotic-assisted prostatectomy (RARP). However, this has not been explored previously. * The primary objective of the present study was to delineate the role of media coverage and marketing of RARP on the Internet, whereas the secondary goal focused on website quality with respect to the presentation of prostatectomy. MATERIALS AND METHODS: * Website content was evaluated for direct-to-consumer advertising after the retrieval of the first 50 websites using Google and Yahoo for each of the terms: ‘robotic prostatectomy, laparoscopic prostatectomy (LP) and open radical prostatectomy (ORP)’. * A linear regression analysis was performed for the annual number of Internet news hits over the last decade for each procedure. Website quality assessment was performed using WHO Honesty on the Internet (HON) code principles. RESULTS: * Of the retrieved sites, the proportion containing direct-to-consumer advertising for RARP vs LP vs ORP using Google was 64% vs 14% vs 0%, respectively (P < 0.001) and, using Yahoo, 80% vs 16% vs 0%, respectively (P < 0.001). * In a linear regression analysis, the r(2) values for news hits for each year over the last 10 years were 0.89, 0.74 and 0.76 for RARP, LP and ORP, respectively. * Website quality assessment found that a minority of the websites were accredited with HONcode principles, with no difference between procedure types (P > 0.05). CONCLUSIONS: * Media coverage and marketing of RARP on the Internet is more widespread compared to LP and ORP. * Disturbingly, the quality of websites using any technique for prostatectomy was of poor quality when using principles of honest information presenting and such findings need to be discussed with respect to obtaining informed consent from patients.
“Does a perioperative belladonna and opium suppository improve postoperative pain following robotic assisted laparoscopic radical prostatectomy? Results of a single institution randomized study: Editorial comments.”
Babayan, R. K. (2011).
Journal of Urology 186(1): 110.
“Posterior Reconstruction Before Anastomosis Improves the Anastomosis Time During Robot-Assisted Radical Prostatectomy.”
Bernie, A. M., A. A. Caire, et al. (2011).
Journal of the Society of Laparoendoscopic Surgeons 14(4): 520-524.
Background and Objectives: Our goal was to evaluate posterior reconstruction of the rhabdosphincter during robot-assisted radical prostatectomy and determine whether this technique decreased anastomotic time of a surgeon in training to perform vesicourethral reconstruction. Methods: We reviewed the first 25 robot-assisted prostatectomies performed by 2 urology surgeons in training (surgeon 1 and surgeon 2). The patient populations were matched for age, Gleason score, clinical stage, and PSA. Whereas surgeon 1 performed the vesicourethral anastomosis without posterior reconstruction, surgeon 2 reapproximated Denonvilliers’ fascia of the posterior bladder to the rhabdosphincter. Time for each surgeon to complete the anastomosis and clinical factors was compared. Results: Surgeon 1 had a median anastomosis time of 25 minutes (range, 17 to 48), whereas surgeon 2 had a median anastomosis time of 15 minutes (range, 10 to 30) (P<0.001). Biopsy Gleason score, pathological tumor stage, perineural invasion, median age at the time of surgery, PSA, prostate weight, and estimated blood loss were not significantly different between surgeons (P>0.05). Pathological Gleason score (P=0.045) and total console time (surgeon 1=216 minutes, surgeon 2=176 minutes; P=0.002) were significantly different between surgeons. Conclusion: Posterior reconstruction prior to anastomosis decreases anastomosis time for robotic surgeons in training. © 2010 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
“Comparison of oncological results, functional outcomes, and complications for transperitoneal versus extraperitoneal robot-assisted radical prostatectomy: A single surgeon’s experience.”
Chung, J. S., W. T. Kim, et al. (2011).
Journal of Endourology 25(5): 787-792.
Background and Purpose: To compare the oncologic results, functional outcomes, and complications of transperitoneal (TP) and extraperitoneal (EP) robotic radical prostatectomy. Patients and Methods: From June 2007 to April 2009, 105 patients underwent TP robotic radical prostatectomy, and 155 patients underwent EP robotic radical prostatectomy. Clinicopathological and perioperative data were compared between the two groups. Postoperative complications and functional outcomes including potency and incontinence were assessed. Results: Patient demographics were similar in the TP and EP groups. No significant differences in positive surgical margins were noted between the groups. The total operative time, number of lymph nodes removed, and estimated blood loss were also not significantly different. However, the robot console time was shorter for the EP group than for the TP group (89.1 vs. 107.8 minutes, p = 0.03). Postoperative pain scale scores were lower in the EP group than in the TP group (2.7 vs. 6.3, p < 0.001). The incidence of ileus and hernia were lower in the EP group; however, the incidence of lymphocele was higher in the EP group. Postoperative potency and continence rates were similar between the groups; however, the EP group had a faster recovery of continence compared with the TP group. Conclusions: The EP approach has similar oncological and perioperative results, less postoperative pain, less bowel-associated complication, and better functional outcomes than those of the TP approach. The EP approach may be an important alternative in robotic radical prostatectomy. © 2011, Mary Ann Liebert, Inc. 2011.
“Posterior rhabdosphincter reconstruction during robotic assisted radical prostatectomy: Results from a phase II randomized clinical trial.”
Coelho, R. F., S. Chauhan, et al. (2011).
European Urology 60(1): 180-181.
“Re: Posterior Rhabdosphincter Reconstruction During Robotic Assisted Radical Prostatectomy: Results from a Phase II Randomized Clinical Trial.”
Coelho, R. F., S. Chauhan, et al. (2011).
European Urology 60(1): 180-181.
“Contemporary referral pattern for robotic prostatectomy.”
Dangle, P. P. and R. Abaza (2011).
Journal of the Society of Laparoendoscopic Surgeons 14(4): 516-519.
Background and Objectives: In spite of the current widespread application of robotic surgery in the treatment of prostate cancer, it remains unclear whether current patterns of use are based on patient benefit or driven by marketing. We sought to investigate this possibility by analyzing the source of our patient population for robotassisted laparoscopic prostatectomy (RALP). Methods: We reviewed 200 consecutive patients who underwent robotic prostatectomy by a single surgeon (RA) at our institution. The source of referral for each patient was analyzed along with individual patient characteristics to identify whether only low-risk or unusually ideal candidates were referred. Results: Of the 200 patients, 90.5% were referred by a urologist with only 5.5% being referred by another urologist at our institution. Only 10 patients cited media or marketing sources as the reason for self-referral, and <10 were referred by primary care physicians or other acquaintances. This referral pattern did not change between the first and second 100 patients. Referred patients included those up to 80 years of age, up to 51kg/m2 in body mass index, and up to Gleason 9 on biopsy, with 36% of those referred by urologists having some history of previous abdominal or prostate surgery. Conclusion: The referral pattern for RALP at our institution may reflect a growing acceptance of robotic surgery among urologists in our region and is unlikely driven by patient-directed marketing. Additionally, urologists may also be more confident in the role of RALP as evidenced by their referral of even complex and higherrisk patients. © 2010 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
“Surgery for prostate cancer.”
Dason, S. and B. Shayegan (2011).
University of Toronto Medical Journal 88(3): 182-189.
Any discussion of the future of medicine should include a discussion of prostate cancer surgery, which is presently one of the most rapidly evolving and technologically advanced areas of medicine. Prostate cancer is the most common cancer in men for which the surgical treatment is radical prostatectomy (RP). RP affords a high chance of cure for localized prostate cancer and has a demonstrated survival benefit. RP has been around for more than a century and has undergone a dramatic evolution culminating in modern techniques that allow for excellent oncologic control and quality of life. A variety of surgical approaches exist for RP including open, laparoscopic, and laparoscopic with robotic assistance. Outcomes, cost, learning curves and usage trends for these approaches are discussed. Conservative options that may precede surgery are also discussed.
“A Critical Systematic Review of Recent Clinical Trials Comparing Open Retropubic, Laparoscopic and Robot-Assisted Laparoscopic Radical Prostatectomy.”
Heer, R., I. Raymond, et al. (2011).
Rev Recent Clin Trials.
The surgical treatment of prostate cancer has evolved rapidly, driven by technological advances that have made minimally-invasive prostatectomy feasible. The contemporary surgical approaches are laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). These are now considered standard modalities of treatment in urology departments across North America, Europe and centres of excellence world-wide. However, despite the widespread adoption of minimally-invasive approaches there are only a handful of robust studies directly comparing the results of these techniques with the gold standard approach of open radical prostatectomy (ORP). Of note, uncertainty remains over exactly which men with localised prostate cancer will benefit from radical treatment and the reduction of surgical side-effects is paramount in optimising outcomes. This systematic review examines the current status of minimally- invasive prostatectomy focussing on peri-operative, oncological and urogenital functional outcomes.
“Laparoscopic repair of extraction site ventral hernia after robotic prostatectomy: institutional experience with 42 consecutive cases.”
Ho, J. and A. Pigazzi (2011).
Introduction: Robotic-assisted laparoscopic prostatectomy (RALP) has become one of the most common laparoscopic procedures in the United States, with over 80,000 cases performed yearly. There is increasing awareness that extraction site ventral hernias (ESVH) are an important cause of morbidity after laparoscopic resective surgery. However, there is no data in the literature concerning ESVH after RALP. The purpose of this study is to report our experience with this novel ESVH and our results with its laparoscopic (LAP) repair. Methods: The charts of all patients subjected to LAP VH repair at the City of Hope National Medical Center between 2005 and 2009 were retrospectively reviewed. Only patients undergoing LAP ESVH after RALP were included in the study. Relevant data analyzed included patient demographics, operative parameters, complications, and recurrence. Results: A total of 42 consecutive male patients were identified, with a median age of 65 years (range 46-81). The median time from RALP to ESVH repair was 10 months (range 1-43). All hernias were periumbilical and all were symptomatic. A laparoscopic left lateral approach was used in all cases. The median operative time was 91 min (range 61-162). The median defect area was 64 cm2 (range 4-176), which was repaired with polytetrafluoroethylene (PTFE) (18 cases) or Marlex composite mesh (24 cases) with a 5-cm overlap. The estimated blood loss (EBL) was minimal in all cases. The median hospital stay was 1 day (range 0-4). Minor complications occurred in 14% of cases. There was no mortality and the recurrence rate was 0%. Conclusions: ESVH after RALP are likely to become a common cause of abdominal wall morbidity in the near future. A laparoscopic repair is safe and effective. Prospective studies are needed in order to further investigate ESVH and ways to reduce its incidence. © 2011 Springer-Verlag.
“Radical retropubic prostatectomy: A review of outcomes and side-effects.”
Hugosson, J., J. Stranne, et al. (2011).
Acta Oncologica 50(SUPPL. 1): 92-97.
Background. Radical prostatectomy (RP) is worldwide probably the most common procedure to treat localized prostate cancer (PC). Due to a more widespread use of Prostate-Specific Antigen (PSA) testing, patients operated today are often younger and have organ confined disease justifying a more preservative surgery. At the same time, surgical technique has improved resulting in lower risk of permanent side-effects. This paper aims to give an overview of results from modern surgery regarding cancer control and side-effects. A brief overview of the history is given. Material and Methods. A literature research identified recently published papers focusing on outcome and side-effects after RP. Results. One large randomized study (SPCG-4) compared RP and watchful waiting (WW). The study showed that RP was superior to WW in preventing local progression (RR = 0.36), distant metastasis (RR = 0.65) and death from PC (RR = 0.65). Observational studies also show a better outcome for men treated with RP compared to WW. Peri-operative mortality after RP is low in most material around 0.1%. The risk of stricture of the vesico-urethral anastomosis has decreased with improved technique from historically 1020% to a low incidence of around 29% today. Also the risk of incontinence has declined with improved technique. However, while the rates of severe incontinence is usually very low, as many as 30% still report light incontinence after long-term follow-up. Erectile dysfunction (ED) is still a frequent side-effect after RP. This risk is dependent on age, pre-operative sexual function, surgical technique and other risk factors for ED such as smoking, diabetes, etc. In selected subgroups the risk of ED is low. Inguinal hernia is a more recently described complication after open retropubic RP with a postoperative incidence of 1520% within three years of surgery. Conclusion. RP is an effective method to achieve cancer control in selected patients. With modern technique it is a safe procedure with a low risk of permanent side-effects except for ED. © 2011 Informa Healthcare.
“[Has time already passed the open radical prostatectomy?].”
Jouko, V. (2011).
Onko avoimen radikaaliprostatektomian aika jo takanapäin? 127(6): 617-620.
Besides radiotherapy, open radical prostatectomy is an established therapy for localized prostatic cancer. Continuous improvements have been made to the surgical technique, with constantly improving results. Erection is preserved in approximately half of the operated patients, and the risk of urinary incontinence is about 3%. In recent years, open surgery has become rivalled by less invasive forms of surgery, laparoscopic prostatectomy and, above all, robotic laparoscopic prostatectomy, by producing slight reductions in the length of the hospital stay and in surgical bleeding. Even so, the costs of surgical operations may increase even twofold, especially with robotic laparoscopic prostatectomy.
“Immediate robot-assisted ureteral reimplantation during robotic prostatectomy in locally advanced prostate cancer.”
Jung, J. H., F. R. P. Arkoncel, et al. (2011).
Journal of Robotic Surgery 5(2): 149-151.
We report the technique and outcomes of immediate robot-assisted ureteral reimplantation due to unexpected ureteral injury during robot-assisted laparoscopic prostatectomy (RALP). A 61-year-old male was diagnosed with locally advanced prostate adenocarcinoma (T3bN0M0). Multiple positive margins at the bladder neck were noted on frozen section during RALP, and re-excision of the bladder neck was done. Unfortunately, the distal third of right ureter was transected. We immediately performed robot-assisted ureteroneocystostomy with double J stent insertion. No complications developed during the follow-up period. © 2011 Springer-Verlag London Ltd.
“Significance of Perineural Invasion, Lymphovascular Invasion, and High-Grade Prostatic Intraepithelial Neoplasia in Robot-Assisted Laparoscopic Radical Prostatectomy.”
Jung, J. H., J. W. Lee, et al. (2011).
Annals of Surgical Oncology.
BACKGROUND: Recently, more detailed histopathological variables such as perineural invasion (PNI), lymphovascular invasion (LVI), and high-grade prostatic intraepithelial neoplasia (HGPIN) have been investigated as prognostic factors for adverse pathologic findings on the radical prostatectomy specimen. We aim to determine whether these pathological factors are associated with adverse pathologic features after robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: All 407 patients who underwent RALP with pelvic lymphadenectomy between July 2005 and December 2009 were analyzed, retrospectively. We investigated the association of these three pathological parameters with adverse pathological findings in RALP specimen and biochemical recurrence using Kaplan-Meier analysis with log-rank test and a multivariate Cox proportional hazard model. RESULTS: The PNI and LVI were significantly associated with a higher pathological stage, a higher pathological Gleason score, a higher tumor volume in RALP specimen, a higher frequency of positive surgical margins, and a higher frequency of seminal vesicle invasion. In addition, PNI correlated with preoperative PSA, clinical stage, and Gleason score on needle biopsy. However, the HGPIN was not significantly associated with the clinicopathological characteristics studied. Using log-rank test, presence of PNI (P < 0.001) increases the probability of biochemical recurrence. On multivariate analysis, all three pathological parameters were not significantly correlated with biochemical recurrence. CONCLUSION: Although presence of PNI and LVI in RALP specimen correlated with multiple adverse clinicopathological factors, it did not predict biochemical recurrence, thus limiting its clinical usefulness. HGPIN was not significantly associated with the clinicopathological characteristics studied.
“Reply from Authors re: Andrew Fuller, Stephen E. Pautler. Additional Evidence for Improved Functional Outcomes Following Robot-Assisted Radical Prostatectomy. Eur Urol. In press. doi: 10.1016/j.eururo.2011.05.037.”
Kim, S. C., C. Song, et al. (2011).
“Combined Robotic Radical Prostatectomy and Robotic Radical Nephrectomy.”
Lavery, H. J., S. Patel, et al. (2011).
Journal of the Society of Laparoendoscopic Surgeons 14(4): 603-607.
A 60-year-old man with prostatic adenocarcinoma and an enhancing left-sided renal mass underwent successful combined robotic radical prostatectomy and robotic radical nephrectomy. We describe the initial report of this combined robotic procedure to remove 2 synchronous urological malignancies and describe our technique. An analysis was conducted of the operating room and postanesthesia care unit charges of this procedure compared with the 2 procedures performed independently. © 2010 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
“Do Silver Alloy-coated Catheters Increase Risk of Urethral Strictures After Robotic-assisted Laparoscopic Radical Prostatectomy?”
Liu, X. S., J. C. Zola, et al. (2011).
Objectives: To evaluate whether the use of silver-coated catheters increased the risk of developing urethral stricture disease after robotic-assisted laparoscopic radical prostatectomy (RALP). Recently, silver alloy-coated Foley catheters have been shown to decrease the risk of catheter-associated urinary tract infections. Other than the increased cost, no disadvantages to the use of these catheters have been reported. Material and Methods: We switched to routine use of the Bardex I.C. silver alloy-coated Foley catheters for all urologic procedures on November 1, 2008. After institutional review board approval, we retrospectively reviewed the records of all consecutive patients who had undergone RALP 12 months before and after the catheter change. The primary outcome was the rate of urethral strictures after RALP. Results: A total of 188 RALPs were performed during the 12 months before the catheter change. No patients who underwent RALP in the months before the catheter change had developed a new postoperative urethral stricture. In the 12 months after the change to the silver-coated catheters, 217 RALPs were performed. Six patients after RALP using silver-coated catheters developed new strictures, at a rate of 2.8% (P = .03). Conclusions: Silver alloy-coated urinary catheters might increase the risk of developing urethral strictures after RALP compared with standard noncoated catheters. Additional evaluation by a large randomized prospective trial is warranted to elucidate the true risk of stricture formation. © 2011 Elsevier Inc. All rights reserved.
“The rapid uptake of robotic prostatectomy and its collateral effects.”
Lowrance, W. T. and D. J. Parekh (2011).
“Incontinence after radical prostatectomy: A patient centered analysis and implications for preoperative counseling.”
Martin, A. D., L. Y. Nakamura, et al. (2011).
Journal of Urology 186(1): 204-208.
Purpose: Incontinence after radical prostatectomy is common yet poorly defined in the current literature. We aimed to accurately characterize incontinence after robot-assisted radical prostatectomy to achieve improved preoperative patient counseling. Materials and Methods: After receiving institutional review board approval we performed a cross-sectional survey of the first 600 patients with prostate cancer who underwent robot-assisted radical prostatectomy at our institution. The International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life and Urinary Incontinence Short Form were used to evaluate incontinence and quality of life after robot-assisted radical prostatectomy. Surveys were mailed by a third party. Data were analyzed on the prevalence of incontinence after robot-assisted radical prostatectomy. More specifically we characterized in detail the nature of incontinence and its effect on quality of life. Results: The response rate was 68% (408 of 600 participants). Response time since surgery was 2.5 months to 4 years. Overall incontinence bother scores and ratings of life interference were quite low. Patients reported that most incontinence occurred during physical activity but 35% reported interference with sleep. Of the patients 31% experienced some anxiety due to urinary difficulties and 51% had to occasionally change clothes due to leakage. Patients did not report much interference with traveling, visiting friends or family and family life. The most bothersome aspects of incontinence were its effects on partner relationship, sexual life and energy levels. Conclusions: Despite patient concerns of incontinence after prostatectomy they report little interference with quality of life. © 2011 American Urological Association Education and Research, Inc.
“The association of robotic surgical technology and hospital prostatectomy volumes: Increasing market share through the adoption of technology.”
Neuner, J. M., W. A. See, et al. (2011).
BACKGROUND: Despite limited and conflicting evidence for the efficacy of newly developed robotic technology for laparoscopic prostatectomy, this technology is spreading rapidly. Because the newer technology is more costly, reasons for this rapid adoption are unclear. The authors of this report sought to determine whether hospital acquisition of robotic technology was associated with volume of prostate cancer surgery. METHODS: The inpatient dataset of claims records from 2002 to 2008 and the acquisition dates of robotic technology were used to examine the rates of prostatectomy in Wisconsin hospitals. In analyses that accounted for hospital and referral region characteristics, changes in hospital prostatectomy volume were examined for their association with technology acquisition. Overall trends in the rate of prostatectomy also were examined over the study period. RESULTS: In total, 10,021 prostatectomies were performed in 52 hospitals in Wisconsin’s 8 health referral regions during the study period. The mean quarterly prostatectomy volume in hospitals that did not acquire the technology was 4.5 in 2002 and 3.1 in 2007/2008. In contrast, the mean quarterly prostatectomy volume in hospitals that went on to acquire robotic technology was 16.5 in 2002 and 24.8 in 2007/2008. In adjusted models, the acquisition of a robot was associated with a 114% annual increase (95% confidence interval, 62%-177% annual increase) in hospital prostatectomy volume. The average Wisconsin hospital prostatectomy volume was unchanged during 2002 through 2006 but increased by 25.6% in 2007. CONCLUSIONS: Robotic technology acquisition occurred rapidly in Wisconsin hospitals, and hospitals that acquired a robot had large increases in prostatectomy volume. Cancer 2011;. (c) 2011 American Cancer Society.
“Re: Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J. B. Malcolm, M. D. Fabrizio, B. B. Barone, R. W. Given, R. S. Lance, D. F. Lynch, J. W. Davis, M. E. Shaves and P. F. Schellhammer. J Urol 2010; 183: 1822-1828.”
Parker, A. S. (2011).
Journal of Urology 185(5): 1983-1984.
“Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study.”
Patel, V. R., R. F. Coelho, et al. (2011).
Journal of Urology.
Purpose: Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies. Materials and Methods: We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2). Results: The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p <0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p <0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p <0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p <0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p <0.001). Conclusions: The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy. © 2011 American Urological Association Education and Research, Inc.
“Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care.”
Stitzenberg, K. B., Y. N. Wong, et al. (2011).
BACKGROUND: Robotic surgery has been widely adopted for radical prostatectomy. We hypothesized that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel. METHODS: A population-based observational study of all prostatectomies for cancer in New York, New Jersey, and Pennsylvania from 2000 to 2009 was performed using hospital discharge data. Hospital procedure volume was defined as the number of prostatectomies performed for cancer in a given year. Straight-line travel distance to the treating hospital was calculated for each case. Hospitals were contacted to determine the year of acquisition of the first robot. RESULTS: From 2000 to 2009, the total number of prostatectomies performed annually increased substantially. The increase occurred almost entirely at the very high-volume centers (>/=106 prostatectomies/year). The number of hospitals performing prostatectomy fell 37% from 2000 to 2009. By 2009, the 9% (21/244) of hospitals that had very high volume performed 57% of all prostatectomies, and the 35% (86/244) of hospitals with a robot performed 85% of all prostatectomies. The median travel distance increased 54% from 2000 to 2009 (P<.001). The proportion of patients traveling >/=15 miles increased from 24% to 40% (P < .001). CONCLUSIONS: Over the past decade, the number of radical prostatectomies performed has risen substantially. These procedures have been increasingly centralized at high-volume centers, leading to longer patient travel distances. Few prostatectomies are now performed at hospitals that do not offer robotic surgery. Cancer 2011;. (c) 2011 American Cancer Society.
“Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: Feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-Loc180 suture.”
Zorn, K. C., H. Widmer, et al. (2011).
Journal of the Canadian Urological Association 5(3): 188-194.
Purpose: Our purpose was to describe the safety and feasi bility ofa running posterior reconstruction (PR) integrated with continuousvesicourethral anastomosis (VUA) using a novel self-cinchingunidirectional barbed suture in robot-assisted radical prostatectomy(RARP).Methods: Between March and October 2010, 30 consecutivepatients with organ-confined prostate cancer underwent RARP byan experienced single surgeon (KCZ). Upon completion of radicalprostatectomy, urinary reconstruction was carried out using2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The lefttail of the suture was initially used for PR (starting at 5-o’clockand ran to re-approximate the retrotrigonal layer to the rectourethralis)followed by left-sided VUA (from 6- to 12-o’clock), whilethe right-sided suture completed the right-sided VUA. Assuranceof watertight closure with an intraoperative 300 cc saline visualcystogram was performed in all cases prior to case completion.Perioperative outcomes and 30-day complications were recorded.Results: All anastamoses were performed without assistance andwithout knot tying. Median time for nurse setup and urinary reconstructionwas 40 seconds (interquartile range [IQR] 25-60) and14.6 min (IQR 10-18), respectively. The need to readjust suturetension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati,OH) to establish watertight closure was observed in 2 cases (7%).No patient had clinical urinary leak and there was no urinary retentionafter catheter removal on mean postoperative day 5 (IQR 4-6).Conclusions: Our clinical experience with a novel technique usingthe interlocked V-Loc suture during RARP for both PR and anastomosisappears to be safe and efficient. Using the barbed sutureprevents slippage and eliminates the need for bedside assistanceto maintain suture tension or knot tying, thus assuring watertighttissue closure. © 2011 Canadian Urological Association.