Use Of Unidirectional Barbed Suture Research Articles

Prospective Interventional Study to Quantify Barbed Suture Exposure at Vaginal Vault and Assess Post-Operative Risk

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

Laparoscopic Uterosacral Ligament Suspension with the Use of Barbed Suture

Video Objective To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension Setting I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Interventions Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Conclusion Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity. To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity.

2336 Unidirectional Barbed Versus Polyglactin 910 Suture for Laparoscopic Vaginal Cuff Closure - A Prospective Comparative Study

Study Objective We compared the use of unidirectional barbed sutures and conventional vicryl sutures for vaginal cuff closure during total laparoscopic hysterectomy. The aim of our study is to evaluate whether the use of unidirectional barbed suture (V-Loc) for vaginal cuff closure is associated with a decrease in vault closure time, operative time, blood loss, and other intraoperative and postoperative complications compared to polyglactin 910 (Vicryl) in patients undergoing total laparoscopic hysterectomy for benign pathology. Design Prospective comparative study. Setting The study conducted at the department of Obstetrics & Gynaecology at AIIMS, Rishikesh from July 2018 to December 2018. Patients or Participants A total of 60 women participated in the study; 30-30 in each group. Interventions All 60 women underwent total laparoscopic hysterectomy due to benign pathology of uterus, vault closure was done with unidirectional barbed suture (v-Loc) in 30 women and with polyglactin 910 (vicryl) in another 30 patients. Measurements and Main Results The mean vault closure time was significantly less with barbed suture (8.84 min) than vicryl group (12.27 min). The mean number of stitches taken was more in barbed suture group (7.46) than vicryl group (7.09), though the difference was not statistically significant. No statistically significant differences were found in operative time, or postoperative outcomes, such as vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. Conclusion The efficacy and safety of unidirectional barbed suture is comparable to the conventional vicryl sutures. Barbed sutures can be safely used to reduce procedure time and surgical difficulty.

Unidirectional barbed suture for vaginal cuff closure without backward stitch in total laparoscopic hysterectomy.

To evaluate the safety and efficacy of unidirectional barbed suture technique for vaginal cuff closure in total laparoscopic hysterectomy (TLH). In a retrospective chart review, data were analyzed from 165 patients who underwent a TLH with an unidirectional barbed suture technique for vaginal cuff closure from January 2012 to June 2016 at tertiary-care university-based teaching hospital and academic affiliated hospital. Vaginal cuff was closed by single layer 3/0 V-Loc unidirectional 9″, 180 day Absorbable Wound Closure Device (Covidien Healthcare, Mansfield, MA) and the suture was not stitched backward to secure distal end. A total of 165 patients were included and the median age was 50 years (range, 35-84 years). The median completion time for hysterectomy time was 100 min (range, 40-240 min) and the median vaginal cuff closure time was 7 min (range, 4-15 min). The median estimated blood loss was 87.8 mL (range 30-250 mL) and the median uterine weight was 200 g (range, 40-900 g). Intraoperative complication included bladder perforation (1.2%) and postoperative complications were vaginal cuff dehiscence (1.8%), cuff cellulitis (0.6%), vesicovaginal fistula (0.6%) and unexplained fever (0.6%). According to the results of current study, the use of unidirectional barbed suture without backward stitching appears to be safe for the vaginal cuff closure in TLH.

The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety.

BackgroundUnidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.AimsThe objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.MethodsWe comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).ResultsThree RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45–-4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52–-0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6–12 months after surgery.ConclusionsOur meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

Use of Unidirectional Barbed Suture in Gynecologic Laparoscopic Surgery

With the developments in technology, lots of innovations were brought into the use of medical society. Suture material including barb technology (V-Lock) is one of them and it is important for doctors who have limited experience in laparoscopic intracorporeal knot tying. In this article; the advantages and disadvantages of this useful absorbable suture material and its utilization in laparoscopic operations will be mentioned.

Use of Unidirectional Barbed Suture in Closure of the Vaginal Cuff during Total Laparoscopic Hysterectomy

To examine the safety, complication rate, and trend of using the V-Loc™ unidirectional barbed suture in closure of the vaginal cuff during total laparoscopic hysterectomy compared to standard suture methods.

Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience

To evaluate the usage of unidirectional barbed suture and its related implications in various surgeon-controlled robotic reconstructive urologic surgeries. From March 2010 to March 2011, all patients undergoing various surgeon-controlled robotic reconstructive urologic surgeries utilizing barbed sutures were prospectively enrolled in this study. Type and number of procedure performed were noted. Intraoperative and peri-operative outcomes potentially related to suture technique and material were recorded. This study reports on 210 patients, in whom barbed suture was used during this period. These included partial nephrectomy (20), pyeloplasty (9), ureteric tailoring and reimplantation (1), closure of bladder after Nephroureterectomy with excision of bladder cuff (8), closure of vaginal cuff in female radical cystectomy (12), partial cystectomy (1), radical prostatectomy (152), simple prostatectomy (2), vesicovaginal fistula repair (3), sacrocolpopexy (1), and hernia repair (1). We encountered 5 instances (2.38%) of tissue cut through possibly attributable to the use of barbed suture and 4 instances of misplacement of suture occurred, of these two required a new suture, whereas retrograde pull back of suture and needle was performed in 2 cases. No instance of slip back/loosening of suture was noted once it was tightened. At mean follow-up of 6.8 (1-14 months) months, we did not encounter any complications of urinary leakage, stone formation or fistula or any clinical evidence of urinary tract obstruction due to the use of barbed suture. Use of unidirectional barbed suture is safe, feasible, and efficient at short-term follow-up for reconstructive part of urological procedures.