Sandwiched posterior-anterior reconstructed tissue-glued anastomosis (SPARTAN) in RARP: A consistently reproducible urethro-vesical anastomosis for early catheter removal and continence recovery

Abstract

Introduction: Restoration of supporting structures around the urethral rhabdosphincter is key to preservation of continence mechanism post-RARP. This video aims to: (1) present the step-by-step SPARTAN technique, a novel easy-to-perform, simplified total anatomical reconstructed UV anastomotic technique incorporating the application of fibrin sealant for added water-tightness; (2) report the short- to intermediate-term outcomes on early day-4 catheter removal and continence recovery. Patients and methods: This video presents a single-surgeon 20-patient RARP series performed with a standardized SPARTAN UV anastomotic technique. Post-operative outcomes measured were the success rate of early Day-4 catheter removal, and patient-reported continence outcome on day-1, -15, -30, -60 and -90 post-catheter removal. The stepby-step SPARTAN technique is outlined sequentially as follows: (1) modified Rocco's Stitch for posterior musculofascial plate reconstruction; (2) the same modified Rocco's Stitch is used to incorporate the 6 O'clock UV anastomosis; (3) completion of anastomosis by Velthoven technique; (4) application of peri‑anastomotic fibrin sealant; and (5) anterior reconstruction. Results: The patient cohort consists of 85% (17/20 patients) low- or intermediate-risk cases by D'Amico classification, and 85% had nerve-sparing RARP. About two-third (75%) of these patients had recovered continence by day-30 post-catheter removal as defined by the usage of one or no safety-liner per-day. Two patients had immediate continence recovery. Ten patients had cystogram at day-4 with none showed any sign of urinary leakage and all but one had successful trial removal of catheter. Conclusion: SPARTAN is an easy-to-perform, simplified total anatomical reconstructed UV anastomotic technique incorporating the application of fibrin sealant around the anastomosis for added water-tightness. SPARTAN is a consistently reproducible, tension-free, water-tight UV anastomotic trechnique in RARP that allows for early catheter removal and continence recovery.

Keywords

• Robotic radical prostatectomy
• Surgical technique
• Anastomosis