Barbed Sutures Are a Safe Alternative to Polyglycolic Acid Sutures for Closure of the Vaginal Cuff at the Time of Robotic Hysterectomy

Abstract

To determine the safety of barbed suture use in the robotic closure of vaginal cuffs. Retrospective medical records review at least 90 days post-operative. Vaginal cuff healing complication (further referred to as “cuff complication”) was defined as cellulitis, abscess, cuff separation, complete dehiscence, or evisceration. Midwestern community hospital. 220 patients who underwent robotically assisted laparoscopic hysterectomy for benign indications from September 2009 through December 2010. Vaginal cuff closure with barbed suture or polyglycolic acid (PGA). Barbed suture was used for vaginal cuff closure in 166 procedures- 145 Quill™ SRS (Angiotech Pharmaceuticals, Inc., San Angelo, TX) and 21 V-Loc™ 180 (Covidien, Mansfield, MA). PGA was utilized in 54 procedures- 32 interrupted, 18 running, 2 locked, and 2 unknown. Mean procedure time for barbed suture was 162 minutes, compared with 185 for PGA (p=0.037). Five cuff complications (3.0%) occurred with the use of barbed suture (4 Quill™ SRS and 1 V-Loc™ 180) compared with one cuff complication (1.9%) with the use of PGA (See Tables 1 & 2). This difference was not significant. All four cuff complications in the Quill™ SRS group occurred in the first four months following its introduction. Further analysis revealed that all four of these complications occurred within the first ten cases in which barbed suture was utilized by the operating surgeon. The single cuff complication in the PGA group occurred in one of the two procedures in which a running locked method was employed. No cuff complications occurred with either an interrupted or continuously run PGA suture.Table 1Vaginal Cuff Complications by Suture TypeCases (n)Cuff Complications (n)Cuff Complications (%)SignificanceBarted SutureQuil SRS14542.8NSV-Lock2114.8NSTotal16653.0NSCases (n)Cuff Complications (n)Cuff Complications (%)Polyglycollic AcidInterrupted3200NSContinuous1800NSLocked2150NSUndocumented200NSTotal5411.9NS Open table in a new tab Table 2Characteristics of Vaginal Cuff ComplicationsComplicationSuture MaterialClosure MethodTime CoursePresentationRepeat SurgeryBMIConcurrent Risk FactorsPartial Cuff SeparationQuil™RunningPoD 25Vaginal bleedingVaginal repair41ObesityPartial Cuff SeparationQuil™RunningPoD 17Vaginal bleedingVaginal repair39Obesity, Diabetes, CAD, HypertensionCuff AbscessQuil™RunningPoD 5Fever, PainVaginal I&D25noneCuff AbscessQuil™RunningPoD 5Fever, Painnone23Diabetes, HypertensionCuff AbscessV-Loc™RunningPoD 4Fever, PainVaginal I&DnoneComplete Dehiscence without EviscerationPGALockedPoD 138Pain with IntercourseVaginal repair x221None Open table in a new tab Barbed suture provides safe and reliable results when utilized for vaginal cuff closure at the time of robotic hysterectomy. The clustering of cuff complications early in our experience is suggestive of a learning curve for the effective use of barbed suture.