The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy

Kim, Su Mi; Baek, Jong Min; Song, Jae Yen; Lee, Sung Jong; Park, Eun Kyung; Kim, Chan Joo; Lee, Yong Seok

doi:10.1007/s00404-017-4637-9

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…7 Pooled estimates of length of hospital stay [days] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: 8 , 27 , 28 , 31 , 40 – 45 , 47 – 51 …”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

Hafermann,

Silas,

Saunders

2023

Arch Gynecol Obstet

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Purpose One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries. Methods We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187. Results In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD – 17.08 min; 95% CI – 21.57, – 12.59), suture time (WMD – 5.39 min; 95% CI – 7.06, – 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD – 44.91 ml; 95% CI – 66.01, – 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD – 1.98 VAS score; 95% CI – 2.83, – 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation. Conclusion This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

Hafermann,

Silas,

Saunders

2023

Arch Gynecol Obstet

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“…Some studies suggested that barbed sutures were associated with lower dehiscence rates compared to braided sutures [ 18 ] or braided and monofilament sutures [ 5 ]. Barbed sutures were also associated with shorter operative time [ 31 , 32 ], less post-operative bleeding [ 14 ], shorter hospital stay [ 33 ] and less vaginal cuff granulation at 6 months post-operatively [ 34 ]. The use of unidirectional barbed suture for vaginal cuff closure was found to be safe, with no major complications reported (in a cohort of 121 patients) [ 35 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature

Jaime Moens,

Buonomo,

De Sutter

2023

JCM

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Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described.

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“…A large systemic review and meta-analysis found that barbed suture decreased the risk for VCD in TLH and RATLH but a sub-analysis looking only at TLH did not find a difference in VCD rate between barbed suture and traditional absorbable suture [3 ▪▪ ]. Several studies, including a systemic review and meta-analysis of 11 studies, showed that there was no significant difference in VCD rate when comparing absorbable barbed, traditional absorbable, and/or permanent suture [3 ▪▪ ,6 ▪ ,18,21 ▪ ,32–34]. With this mixed information, surgeons should use the appropriate suture they are most comfortable with.…”

Section: Intraoperative Prevention Techniquesmentioning

confidence: 99%

“…With this mixed information, surgeons should use the appropriate suture they are most comfortable with. Although it has not been shown to be superior, barbed suture has the benefit of being self-retaining and knotless and has been shown to decrease vaginal cuff closure time [6 ▪ ,21 ▪ ,31,34]. On the downside, barbed suture is more expensive to use and may not be available in low-resource settings [21 ▪ ,32].…”

Section: Intraoperative Prevention Techniquesmentioning

confidence: 99%

Prevention and management of vaginal cuff dehiscence: an updated review

Pinho

Liu

Kim

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewMinimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy. Recent findingsRecent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence.

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The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy

Abstract: Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.

Cited by 5 publications

References 23 publications

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature

Prevention and management of vaginal cuff dehiscence: an updated review

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