Anastomosis

In the Creteil technique, main difference is that these authors use a single circumferential running suture for urethra-vesical anastomosis instead of interrupted sutures (30). A starting knot is performed at the 3 o'clock position outside-in fashion forehand with the right needle holder on the bladder neck and inside-out on the urethra. The short tail of the suture is not cut because it will serve to knot the running suture when it is completed. The posterior half of the running suture consists of 4 to 5 needle passages. After performing the anterior half of the running sutures, anastomosis is completed by knotting at the 3 o'clock.

Recently, van Velthoven et al. (31) described a technique for facilitating the ure-throvesical anastomosis. Two 6-inch sutures (3-0 Vicryl with SH or UR-5 needle) are tied together at their tail ends and delivered into the operative field by way of a 12-mm port. The running sutures is initiated by placing both needles outside-in through the bladder neck and inside-out on the urethra, one needle at the 5:30 position and the other needle at the 6:30 position. A running suture is completed from the 6:30 to the 12:00 o'clock position and from the 5:30 to the 12:00 o'clock position, at the end of which a single intra-corporeal tie is completed.

As described previously, in Heilbronn technique (Table 4), the authors are used to outside knotting for all stitches, whereas the Cleveland and Montsouris groups prefer inside knotting at 5 and 7 o'clock (7,20).

TABLE 7 ■ Advantages and Disadvantages of Both Accesses and Techniques

Extraperitoneal LRP Transperitoneal LRP Advantages

Descending Ascending approach approach Advantages

No contact with bowel Larger room Previous abdominal Less tension on surgery anastomosis Less problems with extravasation

Less bleeding Similarity of open counterpart Familiar anatomical aspect for nerve sparing

Disadvantages

Two peritoneal Previous incision of incisions bleeding part Unfamiliar to open counterpart Different anatomic dissection

No advantages in: Operation time Morbidity Complication rate Positive surgical margin Continence

No advantages in: Operation time Morbidity Complication rate Positive surgical margin Continence

The most relevant advantages of laparoscopic radical prostatectomy should be documented in a decrease of associated morbidity and shorter convalescence compared to open surgery.

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