Bidirectional Barbed Suture for Bladder Neck Reconstruction, Posterior Reconstruction and Vesicourethral Anastomosis During Robot Assisted Radical Prostatectomy

Background: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. Objective: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. Material and methods: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture Results: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. Conclusion: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.

The place of (explicit) grammar within the methods and approaches of foreign language teaching: in the north, in the centre or on the margins?

This article analyzes the role that has been attributed to grammar throughout the history of foreign language teaching, with special emphasis on methods and approaches of the twentieth century. In order to support our argument, we discuss the notion of grammar by proposing a conceptual continuum that includes the main meanings of the term which are relevant to our research. We address as well the issue of "pedagogical grammar" and consider the position of grammar in the different approaches of the "era of the methods" and the current "post-method condition" in the field of language teaching and learning. The findings presented at the end of the text consist of recognizing the central role that grammar has played throughout the history of the methods and approaches, where grammar has always been present by the definition of the contents' progression. The rationale that we propose for this is the recognition of the fact that the dissociation between what is said and how it is said can not be more than theoretical and, thus, artificial.