Use of Barbed Suture in Vaginal Closures after Laparoscopic and Robotic Assisted Laparoscopic Hysterectomy: Evaluation of Perioperative Outcomes and Efficacy

Abstract

Study ObjectiveTo determine the perioperative outcomes and efficacy of barbed sutures for closing the vaginal cuff after laparoscopic and robotic assisted laparoscopic hysterectomy.DesignRetrospective study.SettingCommunity hospitalPatients101 women that underwent laparoscopic hysterectomies (with and without robot).InterventionThe vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180). Patient-demographics, intraoperative and peri-operative data were collected. Fisher's exact test was used for the statistical analysis.Measurements and Main ResultsOne hundred and one women underwent laparoscopic or robotic assisted laparoscopic hysterectomy for benign or malignant indications. Patients had a: (1) Laparoscopic hysterectomy (LH, n=81), or (2) Robotic assisted laparoscopic hysterectomy (RALH, n=20). The vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™, n=25), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180, n=76). Incidence of vaginal dehiscence was 2.9%. There were no statistically difference between LH and RALH. Although the incidence of vaginal dehiscence is higher in the group using V-LOC suture (3.9%) than the group using 0 Quill suture (0%), it was not different statistically (p=0.44). The timing of the dehiscence occurred on day 2, 56, and 70. Increased physical activity was found to be the incident event leading to vaginal dehiscence. The presenting symptoms were vaginal bleeding. All three patients underwent successful vaginal repair with no subsequent dehiscence.ConclusionIn this pilot study, absorbable knotless barbed suture was found to be associated with a dehiscence rate of 2.9%. Delayed strenuous activity to after 120 days from surgery is recommended. Study ObjectiveTo determine the perioperative outcomes and efficacy of barbed sutures for closing the vaginal cuff after laparoscopic and robotic assisted laparoscopic hysterectomy. To determine the perioperative outcomes and efficacy of barbed sutures for closing the vaginal cuff after laparoscopic and robotic assisted laparoscopic hysterectomy. DesignRetrospective study. Retrospective study. SettingCommunity hospital Community hospital Patients101 women that underwent laparoscopic hysterectomies (with and without robot). 101 women that underwent laparoscopic hysterectomies (with and without robot). InterventionThe vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180). Patient-demographics, intraoperative and peri-operative data were collected. Fisher's exact test was used for the statistical analysis. The vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180). Patient-demographics, intraoperative and peri-operative data were collected. Fisher's exact test was used for the statistical analysis. Measurements and Main ResultsOne hundred and one women underwent laparoscopic or robotic assisted laparoscopic hysterectomy for benign or malignant indications. Patients had a: (1) Laparoscopic hysterectomy (LH, n=81), or (2) Robotic assisted laparoscopic hysterectomy (RALH, n=20). The vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™, n=25), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180, n=76). Incidence of vaginal dehiscence was 2.9%. There were no statistically difference between LH and RALH. Although the incidence of vaginal dehiscence is higher in the group using V-LOC suture (3.9%) than the group using 0 Quill suture (0%), it was not different statistically (p=0.44). The timing of the dehiscence occurred on day 2, 56, and 70. Increased physical activity was found to be the incident event leading to vaginal dehiscence. The presenting symptoms were vaginal bleeding. All three patients underwent successful vaginal repair with no subsequent dehiscence. One hundred and one women underwent laparoscopic or robotic assisted laparoscopic hysterectomy for benign or malignant indications. Patients had a: (1) Laparoscopic hysterectomy (LH, n=81), or (2) Robotic assisted laparoscopic hysterectomy (RALH, n=20). The vaginal cuff were closed using either unidirectional barbed Glycolic acid-trimethylene carbonate (0 Quill SRS™, n=25), or bidirectional barbed Polyglycolic acid-polycaprolactone (3-0 V-LOC™ 180, n=76). Incidence of vaginal dehiscence was 2.9%. There were no statistically difference between LH and RALH. Although the incidence of vaginal dehiscence is higher in the group using V-LOC suture (3.9%) than the group using 0 Quill suture (0%), it was not different statistically (p=0.44). The timing of the dehiscence occurred on day 2, 56, and 70. Increased physical activity was found to be the incident event leading to vaginal dehiscence. The presenting symptoms were vaginal bleeding. All three patients underwent successful vaginal repair with no subsequent dehiscence. ConclusionIn this pilot study, absorbable knotless barbed suture was found to be associated with a dehiscence rate of 2.9%. Delayed strenuous activity to after 120 days from surgery is recommended. In this pilot study, absorbable knotless barbed suture was found to be associated with a dehiscence rate of 2.9%. Delayed strenuous activity to after 120 days from surgery is recommended.