"Fish-hook" suturing technique reduces vascular injuries of the pelvic wall during vesico-urethral anastomosis and impacts urinary continence in robot-assisted radical prostatectomy

The objective of the present study was to describe our novel suturing technique, the "Fish-hook", during urethra-vesico anastomosis in a robot-assisted radical prostatectomy procedure. The medical information was extracted from the clinical records of 348 patients with prostate cancer who underwent robot-assisted radical prostatectomy at Chiba Tokushukai Hospital between April 2017 and June 2023. The impact of the "Fish-hook" technique on surgical outcomes was examined by statistical analysis. The "Fish-hook" technique was not used in 123 patients (Group 1) and was used in 225 patients (Group 2). The suturing time for urethra-vesico anastomosis was significantly shorter in Group 2. The number of cases with the needle-driver having no contact with the pelvic wall during anastomosis was 51 vs. 212 cases (Group 1 vs. Group 2; P < 0.01). The hemostasis associated with the injury to the pelvic wall was observed in 14 and 6 cases of Group 1 and 2, respectively. Additionally, Cox proportional hazard models show that urinary continence recovery was shorter in Group 2 than in Group 1 (time to pad 1 per day/pad free is 110/365 days vs. 87/181 days; P = 0.01/< 0.01, respectively) The "Fish-hook" suturing technique showed an excellent outcome regarding urinary continence. This suturing method allows the surgeons to perform sutures in small working spaces without injuring the pelvic wall.