Comparison of leak pressures for single‐layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model*

Kieves, Nina R.; Krebs, Alexander I.

doi:10.1111/vsu.12632

Cited by 17 publications

(39 citation statements)

References 29 publications

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“…In support of our hypothesis, we found that there was no difference in initial leakage pressures between barbed and nonbarbed bladder closures, confirming that the use of barbed suture in an open cystotomy model is as effective as its smooth counterpart. Our findings are consistent with the findings of other studies evaluating the use of barbed suture for diaphragmatic herniorrhapy, 8 gastrotomy and enterotomy closure, 9 skin closure, 7 and canine and equine cystorrhaphy models, 10,11 showing equivalence when compared to conventional smooth suture.…”

Section: Discussionsupporting

confidence: 91%

“…In the barbed group, the majority of the specimens leaked at the preconstructed loop at the beginning of the suture line, whereas in the nonbarbed group the majority of the specimens leaked at the knot. The locations of leakage in this study agree with those of an ex vivo canine cystorrhaphy model using barbed (V‐Loc) suture material . The cause of the observed results likely relate to the fact that there is a length of the suture material devoid of barbs adjacent to the preconstructed end loop, representing a point of uneven tension distribution during filling prior to barb occurrence at a distance of 14 mm from the preconstructed end loop .…”

Section: Discussionsupporting

confidence: 74%

“…This study concluded that closure of porcine bladders with running continuous barbed suture provided a more effective watertight closure that was more rapidly achieved compared with smooth polyglactin 910 suture . Similar studies provided evidence that cystotomy closure with barbed suture was equivalent in bursting strength to closure with conventional suture, and the authors have concluded that barbed suture may offer a viable alternative in laparoscopic bladder surgery in ex vivo equine and canine models …”

Section: Discussionmentioning

confidence: 78%

“…The locations of leakage in this study agree with those of an ex vivo canine cystorrhaphy model using barbed (V-Loc) suture material. 10 The cause of the observed results likely relate to the fact that there is a length of the suture material devoid of barbs adjacent to the preconstructed end loop, representing a point of uneven tension distribution during filling prior to barb occurrence at a distance of 14 mm from the preconstructed end loop. 13 A postulated method to avoid the occurrence of leakage in this location is to position the preconstructed end loop at a greater distance prior to commencing suturing at the beginning of the incision.…”

Section: Discussionmentioning

confidence: 96%

“…23 Similar studies provided evidence that cystotomy closure with barbed suture was equivalent in bursting strength to closure with conventional suture, and the authors have concluded that barbed suture may offer a viable alternative in laparoscopic bladder surgery in ex vivo equine 11 and canine models. 10 Previously reported advantages of barbed suture use in both open and laparoscopic applications are ease of suture placement and a decrease in overall surgical time. 4,6 The use of barbed suture in our study presented a notable time advantage compared with the use of conventional smooth suture closure, in agreement with previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Influence of barbed suture on leak pressures after double‐layer inverting closure of cystotomy sites in sheep

et al. 2018

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Influence of barbed suture on leak pressures after double‐layer inverting closure of cystotomy sites in sheep

et al. 2018

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Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs

Haas

Duffy

Kendall

et al. 2023

Veterinary Medicine & Sci

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Background: Transitional cell carcinoma (TCC) is the most common neoplasia affecting the canine urinary bladder. Partial cystectomy, when used adjuctively with medical management, has been shown to meaningfully extend medial survival time. Surgical stapling devices have a wide variety of uses and advantages over traditional closure methods and, to date, investigation into their use in canine partial cystectomies has not been documented.Objective: To determine the influence of three closure techniques on ex vivo leakage pressures and leakage location following canine partial cystectomy.Methods: Specimens were assigned to one of three closure techniques: simple continuous appositional closure with 3-0 suture, closure with a 60 mm gastrointestinal stapler with a 3.5 mm cartridge, and placement of a Cushing suture to augment the stapled closure, with each group containing 12 specimens. Mean initial leakage pressure (ILP), maximum leakage pressure (MLP), and leakage location at the time that ILP was recorded were compared between groups.Results: Oversewn stapled constructs leaked at significantly higher ILP (28.5 mmHg) than those in the sutured (17 mmHg) or stapled (22.8 mmHg) group, respectively. MLP was greater in the oversewn stapled construct group compared to other groups. Leakage was detected in 97% partial cystectomies, with leakage occurring from the needle holes in 100% of the sutured closure group, from the staple holes in 100% of the stapled only group, and from the incisional line in 83% and from bladder wall rupture in 8% of the augmented staple closure group. All closure methods withstood normal physiologic cystic pressures.Conclusions: Placement of a Cushing suture to augment stapled closures improved the ability of partial cystectomies to sustain higher intravesicular pressures compared with sutured or stapled bladder closures alone. Further in vivo studies are required to determine the clinical significance of these findings and the role of stapling equipment forThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Safety and feasibility of early single‐dose mitomycin C bladder instillation after robot‐assisted radical nephroureterectomy

et al. 2020

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Objectives To assess the safety and feasibility of early single‐dose mitomycin C (MMC) bladder instillation after robot‐assisted radical nephroureterectomy (RARNU) at a tertiary kidney cancer centre. RARNU with bladder cuff excision and subsequent MMC bladder instillation to reduce recurrence risk is the ‘gold standard’ for high‐risk upper urinary tract urothelial carcinoma (UUTUC). We adapted a RARNU technique with precise distal ureteric dissection, bladder cuff excision and watertight bladder closure. Patients and Methods We retrospectively reviewed all patients undergoing RARNU for UUTUC at our centre performed as a standardised transperitoneal procedure comprising of: bladder cuff excision, two‐layer watertight closure and intraoperative bladder leak test; without re‐docking/re‐positioning of the robotic surgical system. Patient demographics, the timing of MMC instillation, adverse events (surgical and potentially MMC‐related) and length of stay (LOS) were assessed according to the Clavien–Dindo classification. Results A total of 69 patients underwent a RARNU with instillation of MMC. The median (interquartile range [IQR]) age was 70 (62–78) years. The median (IQR) day of MMC instillation was 2 (1–3) days and the median (IQR) LOS was 2 (2–4) days, with urethral catheter removal on day of discharge in all cases. Only Grade I Clavien–Dindo complications occurred in seven patients (10%); five had ileus, one a wound infection and one a self‐limiting delirium, all managed conservatively. No adverse events potentially related to MMC instillation were noted within 30 days postoperatively. Conclusion The use of intravesical MMC instillation given in the immediate postoperative period appears feasible and safe in patients undergoing RARNU with intraoperative confirmation of a water‐tight closure ensuring early catheter‐free discharge, with no significant adverse events. The potential reduction in intravesical recurrence in patients receiving early MMC needs to be assessed with longitudinal follow‐up studies.

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Comparison of leak pressures for single‐layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model*

Abstract: This study showed no difference in initial or maximum leak pressure between cystotomy closures with barbed or non-barbed suture under ex vivo conditions. This indicates barbed suture may be appropriate for cystotomy closure but in vivo studies are needed to support this finding.

Cited by 17 publications

References 29 publications

Influence of barbed suture on leak pressures after double‐layer inverting closure of cystotomy sites in sheep

Influence of barbed suture on leak pressures after double‐layer inverting closure of cystotomy sites in sheep

Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs

Safety and feasibility of early single‐dose mitomycin C bladder instillation after robot‐assisted radical nephroureterectomy

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