The Role of Knotless Barbed Suture in Gynecologic Surgery

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Abstract

Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.

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Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture.

Matthew T Siedhoff, Amanda C Yunker, John Steege (2011)

To estimate whether a new surgical technique is associated with lower incidence of postoperative breakdown of the vaginal cuff after laparoscopic hysterectomy or trachelectomy, compared with previous methods of closure. Retrospective cohort study, Canadian Task Force Classification II-3. Tertiary-care university-based teaching hospital. Patients who underwent laparoscopic vaginal closure after removal of the uterus and/or cervix by members of a subspecialty gynecologic laparoscopy division from January 2007 to January 2010 (n = 387). Use of bidirectional barbed suture for laparoscopic vaginal cuff closure. A total of 387 patient records were reviewed. The incidence of vaginal cuff dehiscence among those with other methods of closure was 4.2%, while there were no cases of dehiscence among those who had closure with bidirectional barbed suture (p = .008). Postoperative bleeding (OR 2.3, 95% C.I. 1.3-3.9), presence of granulation tissue (OR 1.9, 95% C.I. 0.92-3.9), and cellulitis (OR 4.6, 95% C.I. 1.0-21.1) all occurred more frequently in patients without barbed suture closure. Dehiscence of the vaginal cuff after laparoscopic closure is a rare but important complication in gynecologic surgery. Use of bidirectional barbed suture eliminated the problem in our first year of experience with the technique. We also observed a decreased incidence of other common problems of the vaginal cuff. This method is easy to learn and inexpensive and does not require advanced skills such as laparoscopic knot-tying. Published by Elsevier Inc.

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Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study.

Franco Alessandri, Valentino Remorgida, Pier Venturini … (2016)

To estimate the effectiveness of unidirectional knotless barbed suture and continuous suture with intracorporeal knots in the repair of uterine wall defects during laparoscopic myomectomy. Randomized clinical study (Canadian Task Force Classification I). Single-center study in a university hospital. This study enrolled 44 women who underwent laparoscopic myomectomy. In accord with to the randomization, the uterine wall defects were closed either with a continuous suture with intracorporeal knots (group V) or a unidirectional knotless barbed suture (group L). The time required to suture the uterine wall defect was significantly lower in group L (11.5 ± 4.1 minutes) than in group V (17.4 ± 3.8 minutes; p <.001). However, no significant difference was observed in the operative time between the 2 study groups. The intraoperative blood loss was significantly lower in group L than in group V (p =.004). The degree of surgical difficulty was significantly lower in group L (3.7 ± 1.1) than in group V (6.1 ± 2.1; p <.001). The unidirectional knotless barbed suture may facilitate the suture of uterine wall defects during laparoscopic myomectomy. When compared with continuous suture and intracorporeal knots, the barbed suture reduces the time required to suture the uterine wall defect and the intraoperative blood loss. Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.

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The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy.

James Greenberg, Jon I. Einarsson (2015)

Bidirectional barbed suture is a new design that incorporates tiny barbs spaced evenly along the length of the suture cut facing in opposite directions from the midpoint. Unlike the smooth-textured traditional suture, the bidirectional barbs on this new product introduce a new paradigm in which wound tension is evenly distributed across the length of the suture line rather than at the knotted end. No knots are required with bidirectional barbed suture. We present a small case series with bidirectional barbed suture to close myometrial defects in laparoscopic myomectomies and vaginal cuffs in total laparoscopic hysterectomies. On the basis of our early experience, we are optimistic that this new suture material is a potentially valuable tool for gynecologic surgeons.