Suture-Free Ureterovesical Anastomosis Using a Microvascular Anastomosis System: Canine Cadaveric Study.

OBJECTIVE: To describe a suture-free ureterovesical anastomosis using a microvascular anastomotic system (MAS) and compare the surgical time and bursting pressure to a sutured ureterovesical anastomosis (SA) with and without an extravesical seromuscular tunnel (EVSMT). STUDY DESIGN: Randomized, unblocked design, ex vivo study. ANIMALS: Three canine cadavers. METHODS: For each cadaver, the ureters were sectioned into 3 equal lengths. The 6 sections were randomly assigned to receive either the MAS or end-side SA. The first cadaver (3 MAS, 3 SA) was used to refine the technique, and the remaining 2 cadavers were used for evaluation. Surgical time and bursting pressure of the anastomosis were compared between MAS and SA (n = 6 per technique). After bursting pressure testing of each anastomosis, an SMT was created over the anastomoses. Bursting pressures were again recorded and compared across techniques. RESULTS: The surgery time was significantly shorter for MAS (median 5.4 minutes) than SA (median 15.8 minutes; P = .002). The bursting pressure was significantly higher for MAS (median 189.5 cmH2 O) than SA (median 64 cmH2 O; P = .002). The bursting pressure for MAS-EVSMT (median 398.5 cmH2 O) was not significantly different from the SA-EVSMT (median 321 cmH2 O, P = .567); however, the creation of an SMT significantly increased the bursting pressure for both techniques (P = .028, respectively). CONCLUSION: This study demonstrated the feasibility of a suture-free ureterovesical anastomosis in the canine cadaver using a commercially available MAS. The MAS anastomosis was faster and resulted in higher bursting pressures than SA. The creation of an SMT improved the bursting resistance of both techniques but there was no difference between the techniques covered by an EVSMT.

Suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system: a cadaveric study.

OBJECTIVE: To describe a suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system (MAS) and to compare surgical time and burst pressure of hand-sewn (HS) ureteral end-to-end anastomosis with the MAS technique. STUDY DESIGN: Experimental ex vivo study. ANIMALS: Canine cadavers (n = 8). METHODS: For each cadaver, 1 ureter was randomly assigned to undergo HS anastomosis and the contralateral ureter had MAS anastomosis. The first 3 cadavers (6 ureters) were used to refine the MAS technique. In the other 5 dogs, surgical time and ureteral burst pressure were compared between groups (n = 5 ureters/group). RESULTS: Preliminary procedures showed that selective impaling of the mucosa and submucosa (without muscularis and adventitia) is necessary to allow complete mechanical interlock of the anastomotic rings for the MAS technique. Median anastomotic time was significantly shorter for MAS (7.6 min) than HS (16.6 min; p = .029) and burst pressure higher for MAS (393 cm H2 O) than HS (180 cm H2 O; p = .012). CONCLUSION: This study demonstrated the feasibility of a suture-free technique of canine ureteral resection-anastomosis using a commercially available MAS. The MAS anastomosis was faster and had higher burst strength compared with the HS anastomosis.