Indian Journal of Urology
SYMPOSIUM
Year
: 2014  |  Volume : 30  |  Issue : 4  |  Page : 418--422

Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis


Srinivas Samavedi1, Haidar Abdul-Muhsin1, Suneel Pigilam1, Ananth Sivaraman2, Vipul R Patel1 
1 Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
2 Consultant Urologist, Apollo Hospital, Chennai, India

Correspondence Address:
Srinivas Samavedi
410 Celebration Place, Suite 200, Celebration, FL 34747
USA

Vesico-urethral anastomosis (VUA) is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP) in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.


How to cite this article:
Samavedi S, Abdul-Muhsin H, Pigilam S, Sivaraman A, Patel VR. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis .Indian J Urol 2014;30:418-422


How to cite this URL:
Samavedi S, Abdul-Muhsin H, Pigilam S, Sivaraman A, Patel VR. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis . Indian J Urol [serial online] 2014 [cited 2022 Jan 24 ];30:418-422
Available from: https://www.indianjurol.com/article.asp?issn=0970-1591;year=2014;volume=30;issue=4;spage=418;epage=422;aulast=Samavedi;type=0