Objective: To describe the technical evolution and perioperative outcomes of vesicourethral anastomosis (VUA) in transvesical (TV) single-port robot-assisted radical prostatectomy (SP-RARP). Materials and Methods: A retrospective review was performed on 189 patients who underwent TV SP-RARP by a single surgeon using the purpose-built SP robotic platform. VUA was completed from within the bladder using two unidirectional V-loc sutures in a continuous, semicircular manner with greater emphasis posteriorly. The most recent 20 cases of TV SP-RARP were selected to evaluate the anastomosis technique and to compare the perioperative outcomes with the first 20 cases of TV SP-RARP performed at our institution. Demographic and clinical data were collected from the prospectively maintained database and statistical analysis was performed. Results: VUA was effectively completed in all cases using the aforementioned technique without any suture breaks, need for conversion, or evidence of intraoperative complication, including urine leak. Marked improvement in the learning curve was observed, which translated to significant reduction in the number of VUA sutures (median: 13 vs 15, p < 0.05) and faster anastomosis time (median: 19.1 vs 33.5 minutes, p < 0.05). The number of anastomotic sutures did not correlate with the prostatectomy specimen weight or volume, especially with both being significantly greater in the latest cases (median weight: 45.1 vs 37.6 g, p < 0.05; median volume: 40.9 vs 36.2 mL, p < 0.05). Postoperative outcomes were favorable with immediate continence achieved in 51.3% of our total cohort and with no patients demonstrating evidence of bladder neck contracture. Conclusion: We provided a detailed technical description of VUA in TV SP-RARP. The improved maneuverability of the SP robotic platform allowed for unique movements to facilitate suture placements from within the confined space of the bladder. The learning curve of a single surgeon was shown in our study, which resulted in notable reduction in the number of sutures, faster anastomosis time, and improved perioperative outcomes.

中文翻译：

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经膀胱单孔机器人根治性前列腺切除术中的膀胱尿道吻合术：技术说明和围手术期结果。

目的：描述经膀胱（TV）单孔机器人辅助根治性前列腺切除术（SP-RARP）中膀胱尿道吻合术（VUA）的技术演变和围手术期结果。材料和方法：对由一名外科医生使用专门构建的 SP 机器人平台接受 TV SP-RARP 的 189 名患者进行了回顾性审查。VUA 是在膀胱内使用两根单向 V-loc 缝合线以连续、半圆形的方式完成的，重点在后面。选择最近的 20 例 TV SP-RARP 病例来评估吻合技术，并将围手术期结果与在我们机构进行的前 20 例 TV SP-RARP 进行比较。从前瞻性维护的数据库中收集人口统计和临床数据并进行统计分析。结果：使用上述技术的所有病例均有效完成了 VUA，没有任何缝线断裂、需要转换或术中并发症（包括漏尿）的证据。观察到学习曲线显着改善，这意味着 VUA 缝线数量显着减少（中位数：13 vs 15，p < 0.05）和更快的吻合时间（中位数：19.1 vs 33.5 分钟，p < 0.05）。吻合缝线的数量与前列腺切除标本的重量或体积无关，特别是在最新病例中两者均显着更大（中位重量：45.1 vs 37.6 g，p < 0.05；中位体积：40.9 vs 36.2 mL，p < 0.05 ）。术后结果良好，51.3% 的患者立即实现了节制，并且没有患者表现出膀胱颈挛缩的证据。结论：我们提供了 TV SP-RARP 中 VUA 的详细技术描述。SP 机器人平台改进的可操作性允许独特的运动，以方便在膀胱的有限空间内放置缝合线。我们的研究显示了单个外科医生的学习曲线，这导致缝合数量显着减少、吻合时间缩短并改善了围手术期结果。