Gary W. Chien

Focus on Details Eliminating knot‐tying during the vesico‐urethral anastomosis in robot‐assisted laparoscopic radical prostatectomy

A continuous vesico-urethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP) is becoming standard procedure. First described by Hoznek et al. [1], the technique has subsequently been adopted by other large centres performing LRP [2,3]. Van Velthoven et al. [4] further modified this technique by describing a single-knot technique for VUA; two 15 cm polyglycolic acid sutures were tied together at their tail ends and delivered into the field via a 12-mm port. A continuous suture was completed from the 6.30 to the 12 o’clock position and from the 5.30 to the 12 o’clock position, at the end of which a single intracorporeal tie was completed. Unfortunately, once a continuous anastomotic suture is tied, further tensioning is impossible. The Lapra-Ty® clip (Ethicon Endosurgery, Cincinnati, OH, USA) was designed to eliminate the need for intracorporeal knot-tying, thus making the operation technically simpler and reducing the duration. We report our experience using the Lapra-Ty clip to eliminate the need for knot-tying and tension-holding during the VUA of robot-assisted RALRP.