Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue.

Abstract

OBJECTIVE: To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. STUDY DESIGN: Cadaveric ex vivo study. STUDY POPULATION: Twenty-eight canine bladders with urethra. METHODS: Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. RESULTS: Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8&#x2009;minutes (range, 19.3-39.2) for the I group and 17.3&#x2009;minutes (range, 9.2-21.3) for the C group (P&#x2009;<&#x2009;.0001). The median leakage pressure was 10.9&#x2009;mm Hg (range, 4.1-29.7) for the I group and 10.8&#x2009;mm Hg (range, 6.2-18.5) for the C group (P&#xa0;=&#xa0;.94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P&#xa0;=&#xa0;.96). The distribution of the site of leakage was similar between groups (P&#xa0;=&#xa0;.381). CONCLUSION: Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. CLINICAL SIGNIFICANCE: This study represents the first step toward laparoscopic radical prostatectomy in dogs.