Impact of barbed suture in controlling the dorsal vein complex during laparoscopic radical prostatectomy.

OBJECTIVE: To compare applications of unidirectional knotless barbed suture and traditional two single polyglactin sutures for dorsal vein complex (DVC) control during laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: This was a non-randomized, prospective matched-pair pilot study. Thirty-one LRP cases with barbed suture (V-Loc®) were match-paired with 31 LRP cases in which traditional two single polyglactin stitches according to patient's prostate volume and body mass index (BMI) were used. Time needed for DVC ligation, DVC control and operation time were recorded. Peri- and postoperative parameters were noted. Statistical analyses were performed. RESULTS: Mean age was 65.4±6.3 years. Mean follow-up was 20.2±3.3 months. Mean BMI and prostate volume were similar in both groups. Mean preoperative clinical stage, Gleason score, and PSA were comparable between both groups. Mean DVC ligature time and mean DVC controlling time in group 1 were statistically shorter than in group 2 (p=0.04, p<0.001). Continence rates were significantly higher in group 1 than in group 2 in early follow-up (p=0.005).

Iatrogenic direct rectal injury: an unusual complication during suprapubic cystostomy (SPC) insertion and its laparoscopic management.

Suprapubic cystostomy (SPC) is commonly used, instead of indwelling urethral catheter- ization, as indicated in many pathological conditions. Although considered to be a safe procedure that can be easily performed in an outpatient basis several complications have been reported in international literature. Bowel injury can be a serious complication with the small intestine affected in the majority of cases. We present a case of an acci- dental rectal injury by a suprapubic catheter misplacement, in a 76 year old demented patient with prostatic hyperplasia and chronic urinary retention. The injury was confirmed by cystogra- phy and injection of contrast meterial through the suprapubic catheter, and successfully treated laparoscopically by an extraperitoneal approach. The patient was discharged after 10 days with- out any complications. The above method, in experienced hands, can be an effective primary treatment option for such rare but devastating complications. The case and management is unique as, to our knowledge, as no similar cases have been presented.

In Vivo Comparison of "V-Loc 90 Wound Closure Device" With "Vicryl" and "Monocryl" in Regard to Tissue Reaction in a Rabbit Bladder Model.

OBJECTIVE: To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS: Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS: The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION: The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.

Comparison of laparoscopic closure of the bladder with barbed polyglyconate versus polyglactin suture material in the pig bladder model: an experimental in vitro study.

PURPOSE: The objective of this randomized in-vitro study was to compare the suturation time, integrity, and quality of the bladder closure in fresh cadaver pig bladders performed with barbed polyglyconate sutures vs polyglactin 910 sutures in running and interrupted fashion. MATERIALS AND METHODS: Forty-eight pig bladders, each weighing from 120 to 150 g, were randomly divided into three groups: Group 1 (interrupted polyglactin 910 suture group), group 2 (running polyglactin 910 suture group), and group 3 (running barbed polyglyconate suture group). The bladder defects were closed laparoscopically, and the suturation times were noted. Two surgeons evaluated the integrity of each bladder closure. A cystometry was performed, and the filling and leak pressures were noted. A Kruskal-Wallis variance analysis test was used to compare the results of the three groups, and P<0.05 was considered significant. RESULTS: There was a statistically significant difference between the mean suturation times of three groups: Group 1, 15.2 minutes; group 2, 9.14 minutes; and group 3, 7.13 minutes (P<0.05). Mean bladder capacity at the time of leakage was 276.2, 353.8, and 419.7 mL for groups 1, 2, and 3, respectively, and the difference was statistically significant (P<0.05). CONCLUSION: For the first time, we demonstrated laparoscopic knotless closure of bladder defects using the barbed polyglyconate suture material in an experimental in-vitro model. Closing the pig bladder with running knotless barbed suture provides a more effective and faster watertight bladder closure than traditional polyglactin 910 suture material.