QUIK-STITCH^® ENDOSCOPIC SUTURING SYSTEM

Use of the PARE Quik-Stitch Endoscopic Suturing System Dramatically Improves Operative Time in laparoscopic radical prostatectomy.

James P. Brown, MD Staff Urologist

Resurrection Medical Center
Chicago, Illinois

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C L I N I C A L  R E P O R T  U R O L O G Y

Over the past six months I have found the Quik-Stitch device to be extremely useful in laparoscopic urological procedures, including pyeloplasty and partial nephrectomy, but especially in radical prostatectomy. This article intends to describe the uses of the Quik-Stitch device in laparoscopic radical prostatectomy

I.      Attachment of the Puboprostatic Ligaments
        To The Anterior Urethal Stump

We have found that this technique helps prevent retraction of the urethral stump, and may have a role in improving postoperative continence. After division of the Dorsal venous complex and the uretha, the Quik-Stitch is used to quickly and accurately attach the urethral stump to the puboprostatic ligament stumps. The pre-tied knot prevents time-consuming intracorporeal suturing and allows rapid progression to the next step of surgery.

II.      Urethrovesical Anastomosis

This is where the Quik-Stitch is worth its weight in gold. Anastamotic sutures can be placed with precision, using either straight or curved needles and knots can be gently guided down until snug. This avoids the hour-eating dread of intracorporeal knot-tying and represents a huge leap over other systems that place too much tension on the suture and don't allow for ease of knot placement. Use of the Quik-Stitch has cut at least 30-60 minutes off of our operative times. A routine 3.5 hours has become a timely 2-2.5 hours. Sutures are easily placed and carefully snugged into position. Additional sutures are easy to place and require very little time. Short suture runs are possible, though we tend to interrupt our anastomoses, mirroring the open technique.

We have also found the Quik-Stitch to be helpful in decreasing the operative time in both laparoscopic pyeloplasty and laparoscopic partial nephrectomy. However, the greatest improvement for us has been in laparoscopic radical prostatectomy, which is becoming a more common procedure and now can compete with open radical prostatectomy in terms of operative time - thanks to the innovators at PARE.