A novel circumferential bladder neck suture to facilitate vesicourethral anastomosis during radical retropubic prostatectomy

Disruption of the vesicourethral anastomotic sutures during tying is not uncommon. Reapplication of sutures is often difficult. The novel circumferential bladder neck suture provides a unique way of achieving tissue apposition without tension in a reliable and reproducible fashion. The reliability and reproducibility makes it an ideal technique for using in the training of trainee surgeons. When the anastomotic sutures are tied without this technique, the surgeon tries to achieve the multiple objectives of tissue apposition, correct alignment and proper knot placement in the cramped and confined space of the pelvis with poor visibility. Mastering these objectives requires considerable experience. The circumferential bladder neck stitch achieves tension-free tissue apposition in a reliable and secure fashion. The axial traction leads to perfect alignment of the vesicourethral edges. In this position the process of knot-tying is simplified. The knots can be tied by hand, with an instrument or by using a sliding, pre-formed knot under vision. This versatility makes this technique extremely user-friendly and relatively easy to master, and hence it might also potentially reduce the learning curve for vesicourethral anastomosis during RRP, especially for inexperienced surgical trainees. This technique has been used equally effectively with a continuous bladder neck suture. In the initial phases of technical refinement, the authors used this suture to salvage anastomoses that needed to be redone because of suture disruption while using standard anastomotic techniques. In addition, feedback from trainees about the procedure was extremely favourable in terms of its simplicity, time taken to learn the technique and shortening the time taken to perform the anastomosis compared with standard techniques. A prospective study is currently underway to determine the impact of the technique on the learning curve of surgical trainees and on short-term and long-term patient outcomes. Thus far, this technique has been used in 70 consecutive open RRP procedures.