Abstract
Purpose
Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological procedures nowadays. Minimally invasive procedures seem to increase the risk of vaginal cuff dehiscence (VCD). Barbed suture is a new class of suture introduced to aid surgeons during laparoscopic suturing, with the aim to reduce operative time, blood loss, and vaginal dehiscence.
Methods
We identified all articles that report a series of laparoscopic or robotic-assisted hysterectomy using barbed suture compared to conventional suture for vaginal cuff closure. The main outcome measures were vaginal cuff suturing time, vaginal bleeding, and vaginal dehiscence with or without small bowel evisceration. Suturing time was meta-analyzed as the standardized mean difference, which is the difference in means of two arms divided by pooled standard deviation with 95 % confidence intervals. For vaginal bleeding and dehiscence risk difference were calculated for each study and then meta-analyzed. Fixed models were considered if heterogeneity was low (I 2 < 50 %), otherwise random models were preferred.
Results
We show that minor bleeding (RD = 0, 95 % CI 0.03–0.03; p value = 0.907) and VCD (RD = −0.01, 95 % CI 0.02–0.00; p value = 0.119) are comparable in minimally invasive hysterectomy with or without the use of barbed suture. The major bleeding (RD = −0.03; 95 % CI 0.05–0.00; p value = 0.047) appears borderline significant, but the difference between the two types of sutures is not high and the upper limit of 95 % IC is equal to 0 so they were considered comparable. Instead, meta-analysis on vaginal cuff suturing time demonstrates that suturing time is reduced with the use of barbed suture (SMD = −0.96, 95 % CI 1.26–0.70; p value <0.001).
Conclusions
Barbed suture is safe and well tolerated as traditional sutures and is associated with reduced operative time of laparoscopic vaginal vault closure.
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References
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG (2007) Hysterectomy rates in the United States. Obstet Gynecol 110:1091–1095
ACOG. Commitee Opinion No. 444, 2009. Obstet Gynecol 114:1156–1158
Iavazzo C, Gkegkes ID (2014) Single-site port robotic-assisted hysterectomy:a systematic review. Arch Gynecol Obstet 289:725–731
Einarsson JI, Vellinga TT, Twijnstra AR, Chavan NR, Suzuki Y, Greenberg JA (2010) Bidirectional barbed suture: an evaluation of safety and clinical outcomes. JSLS 14(3):381–385
Greenberg JA (2010) The use of barbed suture in Obstetrics and Gynecology. Rev Obstet Gynecol 3(3):82–91
Siedhoff MT, Yunker AC, Steege JF (2011) Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture. J Minim Invasive Gynecol. 18(2):218–223
Medina BC, Giraldo CH, Riaño G, Hoyos LR, Otalora C (2014) Barbed suture for vaginal cuff closure in laparoscopic hysterectomy. JSLS 18(1):83–88
Bassi A, Tulandi T (2013) Evaluation of total laparoscopic hysterectomy with and without the use of barbed suture. J Obstet Gynaecol Can. 35(8):718–722
Morgan-Ortiz F, Contreras-Soto JO, Soto-Pineda JM, Zepeda MA, Peraza-Garay FJ (2013) Comparison between unidirectional barbed and polyglactin 910 suture in vaginal cuff closure in patients undergoing total laparoscopic hysterectomy. Surg Technol Int. 23:43–148
Blikkendaal MD, Twijnstra ARH, Pacquee SCL, Rhemrev JPT, Smeets MJGH, de Kroon CD, Jansen FW (2012) Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. Gynecol Surg 9(4):393–400
Einarsson JI, Cohen SL, Gobern JM, Sanberg EM, Hill-Lydecker CI, Wnag K, Brown DN (2013) Barbed versus standars suture: a randomized trial for laparoscopic vaginal cuff closure. J Minim Invasive Gynecol 20(4):492–498
Ardovino M, Castaldi MA, Fraternali F, Ardovino I, Mosca L, Colacurci N, Signoriello G, Cobellis L (2013) Bidirectional barbed suture in total laparopscopic hysterectomy and lymphnode dissection for endometrial cancer: technical evaluation and 1 year follow up of 61 patients. J Laparoendosc Adv Surg Tech A 23(4):347–350
Bogliolo S, Nadalini C, Iacobone AD, Musacchi V, Carus AP (2013) Vaginal cuff closure with absorbable bidirectional barbed suture during total laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 70(1):219–221
Song T, Lee SH (2014) Barbed suture versus traditional suture in single-port laparoscopic hysterectomy. J Minim Invasive Gynecol. doi:10.1016/j.jmig.2014.03.012
Neubauer NL, Schink PJ, Pant A, Singh D, Lurain JR, Schink JC (2013) A comparison of 2 methods of vaginal cuff closure during robotic hysterectomy. Int J Gynaecol Obstet 120(1):99–101
Nawfal KA, Eisenstein D, Theoharis E, Dahlman M, Wegienka G (2012) Vaginal cuff closure during robotic/assisted total laparoscopic hysterectomy: comparing vicryl to barbed sutures. JSLS 16(4):525–529
Chayachinda C, Hackethal A, Tinneberg HR (2012) How to close a colpotomy? Barbed suture and conventional suture effects on soft tissue: an ex vivo pilot study. Arch Gynecol Obstet 285:1633–1636
Ceccaroni M, Berretta R, Malzoni M, Scioscia M, Roviglione G, Spagnolo E, Rolla M, Farina A, Malzoni C, De Iaco P, Minelli L, Bovicelli L (2011) Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study. Eur J Obstet Gynecol Reprod Biol 158(2):308–313
Somkuti SG, Vieta PA, Daugherty JF, Hartley LW, Blackkmon EB (1994) Transvaginal evisceration after hysterectomy in premenopausal women: a presentation of three cases. Am J Obstet Gynecol 171:567–568
Kowalski LD, Seski JC, Timmins PF, Kanbour AI, Kunschner AJ, Kanbour-Shakir A (1996) Vaginal evisceration: presentation and management in postmenopausal women. J Am Coll Surg 183:225–229
Tulikangas PK, Smith T, Falcone T, Boparai N, Walters MD (2001) Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 75:806–810
Rd Tucker, Platz CE, Landas SK (1997) Histologic characteristics of electrosurgical injuries. J Am Assoc Gynecol Laparosc 4:201–206
Gruber DD, Warner WB, Lombardini E, Zahn CM, Buller JL (2011) Laparoscopic hysterectomy using various energy sources in swine: a histopathologic assessment. Am J Obstet Gynecol. doi:10.1016/j.ajog.2011.07.009
Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M, Bolis P (2012) Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of literature. Obstet Gynecol 12(3):516–523
Quibel S, Roman H, Marpeau (2012) Volvulus following barbed suture. Gynecol Obstet Fertil 40(6):382–383
Vahanian SA, Finamore PS, Lazarou G (2014) Delayed small bowel obstruction after robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg 21:e11–e13. doi:10.1097/SPV.0000000000000101
Burchett MA, Mattar SG, McKenna DT (2013) Iatrogenic intestinal and mesenteric injuries with small bowel volvulus following use of barbed suture during laparoscopic myomectomy. J Laparoendosc Adv Surg Tech 23(7):632–634
Donnellan NM, Mansuria SM (2011) Small bowel obstruction resulting from laparoscopic vaginal cuff closure with a barbed suture. J Minim Invasive Gynecol 18(4):528–530
Conflict of interest
The work was supported by own funding. All the Authors declare that no financial and personal relationships with organizations or people that could inappropriately influence their work are present. All the Authors declare that no conflicts of interest exist.
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Bogliolo, S., Musacchi, V., Dominoni, M. et al. Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 292, 489–497 (2015). https://doi.org/10.1007/s00404-015-3653-x
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DOI: https://doi.org/10.1007/s00404-015-3653-x