Use of titanium knot placement device (TK-5) to secure dorsal vein complex during laparoscopic radical prostatectomy and cystoprostatectomy

We evaluated the feasibility and describe the surgical technique of using the Ti-Knot device TK-5 to secure the dorsal vein complex (DVC) during 20 consecutive cases of laparoscopic radical prostatectomy and cystoprostatectomy. Bloodless DVC ligation and transection was successfully achieved in 19 (95.03%) of 20 cases. In only 1 case, venous bleeding occurred after DVC transection. However, in this case, the two stitches used to ligate the DVC were tightly tied, and the bleeding probably occurred because the stitches were passed too superficially on the DVC. In another case, a third stitch had to be placed and tied with the aid of the Ti-Knot device because the second 2-0 Vicryl stitch placed at the DVC broke. In only 1 case did we experience some degree of trouble with the knotting process because one of the ends of the Vicryl suture slipped back into the abdominal cavity. The time to tie each suture with the Ti-Knot device, defined after the moment the needle was passed underneath the DVC to the moment the titanium knot was crimped and the Vicryl suture trimmed, was less than 1 minute (median 50 seconds, range 45 to 56) in all cases, except the case described above. No cases of the Ti-Knot device misfiring or malfunction occurred in this series. In our experience, the Ti-Knot titanium knot placement device proved to be safe and efficient during laparoscopic ligation and control of the DVC.