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Deo JK, Mehra P, Sharma R, Rehan HS. Does Unidirectional Polyglycolide Caprolactone Barbed Suture Have Improved Outcomes Over Non-barbed Suture When Applied for Intra-oral Incision Closure? J Maxillofac Oral Surg 2024; 23:81-87. [PMID: 38312973 PMCID: PMC10830978 DOI: 10.1007/s12663-023-02000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/08/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose The choice of wound closure material may influence the clinical outcomes of intra-oral incision closure. Studies evaluating the application of barbed suture in the oral cavity are scarce. Hence, the present study was carried out with the aim to monitor and compare the efficacy and ease of handling of monofilament polyglycolide caprolactone (PGCL) unidirectional barbed and non-barbed sutures used for intra-oral incision closure in patients undergoing transalveolar extraction of impacted mandibular third molar and mandible fracture open reduction internal fixation. Methods A prospective randomized open label study was carried out among subjects requiring intra-oral incision closure following mandibular third molar extraction and isolated mandible fracture fixation. The difficulty index of the impacted third molars was evaluated pre-operatively. Subjects were randomized to receive either 3-0 monofilament PGCL unidirectional barbed or non-barbed sutures. Incision closure time and ease of suture handling were recorded intra-operatively. Post-operatively, patients were monitored for incision healing using the Hollander wound evaluation scale (HWES) and intensity of pain using visual analog scale (VAS) on post-operative days 1, 3 and 7. Data analysis involved descriptive statistics, Chi-square, unpaired t test and multivariate analysis using the IBM SPSS-PC software (v.25.0). Results A total of 60 subjects completed the study protocol, who were randomized into two groups (n1 = n2 = 30), comparable in terms of age, gender and treatment (TAE = 51; ORIF = 9) received. The incision healing outcomes were significantly better (p = 0.016) with barbed suture using HWES on day 7. The mean closure time using barbed suture (142.50 ± 34.803 secs) was significantly (p = 0.001) shorter than that with non-barbed suture (204.56 ± 52.94 secs). The mean VAS for the barbed suture (0.97 ± 1.89) was less (p = 0.015, 95% CI) than the non-barbed suture (2.50 ± 2.91) on day 3. The suture handling ease was comparable between the two groups. Conclusion Monofilament unidirectional PGCL barbed suture has merits over the non-barbed suture with regards to superior post-operative incision healing, reduced incision closure time (43%), lower post-operative pain and comparable ease of suture handling. Hence, knotless PGCL suture is a promising alternative for intra-oral surgical incision closure in oral and maxillofacial surgery.
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Affiliation(s)
| | - Pravesh Mehra
- Lady Hardinge Medical College, New Delhi, Delhi India
| | - Rakesh Sharma
- Lady Hardinge Medical College, New Delhi, Delhi India
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Cannone FG, Cormaci L, Ettore C, Gulino FA, Incognito GG, Benvenuto D, Ettore G. Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:90. [PMID: 38256351 PMCID: PMC10821056 DOI: 10.3390/medicina60010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.
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Affiliation(s)
- Francesco Giuseppe Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Livia Cormaci
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Carla Ettore
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Giosuè Giordano Incognito
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
| | - Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95122 Catania, Italy; (F.G.C.); (L.C.); (C.E.); (G.G.I.); (G.E.)
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Jaime Moens B, Buonomo A, De Sutter P. Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature. J Clin Med 2023; 12:4187. [PMID: 37445221 DOI: 10.3390/jcm12134187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
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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Affiliation(s)
- Babette Jaime Moens
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Antonino Buonomo
- Department of Gynaecology, Centre Hospitalier Universitaire Tivoli, Avenue Max Buset 34, 7100 La Louviere, Belgium
| | - Philippe De Sutter
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
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Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy. Taiwan J Obstet Gynecol 2023; 62:12-15. [PMID: 36720523 DOI: 10.1016/j.tjog.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery. MATERIALS AND METHODS The medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared. RESULTS RM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups' surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation. CONCLUSIONS Although more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.
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Effects of Using Barbed Suture in Myomectomy on Adhesion Formation and Adverse Pregnancy Outcome. J Pers Med 2022; 13:jpm13010092. [PMID: 36675753 PMCID: PMC9862078 DOI: 10.3390/jpm13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.
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Reproductive Outcomes after Laparoscopic Myomectomy: Conventional versus Barbed Suture. J Minim Invasive Gynecol 2021; 29:77-84. [PMID: 34182139 DOI: 10.1016/j.jmig.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To study the reproductive outcomes after laparoscopic myomectomy comparing conventional (nonbarbed) suture with barbed suture used for myometrial defect closure. DESIGN Monocentric retrospective cohort study with prospective follow-up survey for reproductive outcomes conducted in April and May 2020. SETTING Tertiary care center (center for advanced gynecologic laparoscopy and infertility). PATIENTS Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 to December 2017. INTERVENTIONS Laparoscopic myomectomy with closure of the myometrium using either conventional (nonbarbed suture) or barbed suture and follow-up survey regarding reproductive outcomes. MEASUREMENTS AND MAIN RESULTS The outcomes measured included the rate of conception, pregnancy complications, mode of delivery, and perioperative complications for both kinds of suture materials used. Of the 399 women who underwent laparoscopic myomectomy, 343 satisfied the inclusion criteria and were followed up; 235 patients responded. A total of 120 patients were included in the nonbarbed group (group A), and 115 patients were included in the barbed group (group B). A total of 182 (group A: 97 vs group B: 85; p = .204) women had actively sought pregnancy postoperatively, of whom 93 (51.09%) in total and 51 (54.8%) in group A vs 42 (45.1%) in group B reported at least 1 pregnancy with no significant difference in the incidence rate ratios between the 2 groups. Of the recorded pregnancies84.9% (group A: 88.2% vs group B: 80.9%) live births, 6.4% (group A: 5.8% vs group B: 7.1%) had first-trimester miscarriages, 2.1% (group A: 1.9% vs group B: 2.3%) had an ectopic pregnancy, and 6 were ongoing pregnancies at the time of the study analysis, which were compared statistically between both study groups. Pregnancy-related complications were noted in 12 of the 93 pregnant women (12.9%), which were comparable in both groups. No case of uterine rupture was reported. CONCLUSION Our study supports good reproductive outcomes in women after laparoscopic myomectomy with barbed sutures. Furthermore, the inclusion of nonbarbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are as safe as, and an easier alternative to, conventional sutures without affecting pregnancy outcomes.
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Pepin K, Dmello M, Sandberg E, Hill-Verrochi C, Maghsoudlou P, Ajao M, Cohen SL, Einarsson JI. Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy. J Minim Invasive Gynecol 2020; 27:1566-1572. [PMID: 32109590 DOI: 10.1016/j.jmig.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE To review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture. DESIGN Retrospective cohort study and follow-up survey. SETTING Single, large academic medical center. PATIENTS Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016. INTERVENTION Laparoscopic myomectomy and a follow-up survey regarding pregnancy outcome. MEASUREMENTS AND MAIN RESULTS A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2-72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported. CONCLUSION According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.
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Affiliation(s)
- Kristen Pepin
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou).
| | - Monalisa Dmello
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou)
| | - Evelien Sandberg
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou); Leiden University Medical Centre, Leiden, The Netherlands, (Dr. Sandberg)
| | - Catherine Hill-Verrochi
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou); Baystate Medical Center, Springfield, Massachusetts (Dr. Hill-Verochi)
| | - Parmida Maghsoudlou
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou)
| | - Mobolaji Ajao
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou)
| | - Sarah L Cohen
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou); The Mayo Clinic, Rochester, Minnesota (Dr. Cohen)
| | - Jon I Einarsson
- Department of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston Massachusetts. (Drs. Pepin, Dmello, Sandberg, Hill-Verrochi, Ajao, Cohen, Einarsson, and Ms. Maghsoudlou)
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An Alternative Approach to Posterior Colporrhaphy Plication Using Delayed Absorbable Unidirectional Barbed Suture. Female Pelvic Med Reconstr Surg 2020; 26:107-110. [PMID: 31990797 DOI: 10.1097/spv.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deroy C, Hahn H, Bismuth C, Ragetly G, Gomes E, Poncet C. Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases. J Am Anim Hosp Assoc 2019; 55:152-159. [PMID: 30870607 DOI: 10.5326/jaaha-ms-6879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19-43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6-36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.
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Affiliation(s)
- Claire Deroy
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
| | - Harriet Hahn
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
| | - Camille Bismuth
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
| | - Guillaume Ragetly
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
| | - Eymeric Gomes
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
| | - Cyrill Poncet
- From Clinique Veterinaire Alliance, Bordeaux, France (C.D.); and Center Hospitalier Vétérinaire Fregis, Acrueil, France (H.H., C.B., G.R., E.G., C.P.)
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Tan WH, McAllister JM, Blatnik JA. Efficacy of robotic versus open transversus abdominis release in a porcine model. Hernia 2019; 23:29-35. [PMID: 30370479 DOI: 10.1007/s10029-018-1836-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Transversus abdominis muscle release (TAR) combines retromuscular mesh placement with posterior component separation and muscle release. TAR is usually an open technique for abdominal wall reconstruction; however, several centers have performed this operation robotically and claim better clinical outcomes when compared to open surgery. We sought to compare robotic versus open TAR utilizing a porcine model. METHODS Animals were randomized to open versus robotic TAR with mesh placement, survived for 4 weeks, then underwent diagnostic laparoscopy to assess adhesive burden and adhesion tenacity. T-peel testing was utilized to assess mesh ingrowth. The primary outcome was adhesive burden; secondary outcomes included mesh incorporation, contraction, and operative time. RESULTS Nine robotic and eight open TARs were performed. Mean operative time was significantly shorter for the open cases compared to robotic cases (88.6 ± 12.9 min versus 228.3 ± 46.2, p < 0.01). Operative time in the robotic arm of the study decreased over time, from 300 to 165 min. No difference was seen in the mean adhesion area between the two groups. Adhesion tenacity and mesh flatness were similar. The work required to peel the mesh off surrounding tissue was significantly higher in the open TAR than in the robotic TAR group: 52.6 ± 15.5 and 32.9 ± 10.6 mJ/cm2, respectively (p < 0.01). CONCLUSIONS There were no differences in adhesions between the robotic and open approaches, but greater mesh contraction and ingrowth was observed in the open TAR group. Though operative time was longer in the robotic group, time dropped by about 40% from the first case to the last.
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Affiliation(s)
- W H Tan
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA.
| | - J M McAllister
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
| | - J A Blatnik
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
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Giusto G, Iussich S, Tursi M, Perona G, Gandini M. Comparison of two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. Acta Vet Scand 2019; 61:3. [PMID: 30611301 PMCID: PMC6321647 DOI: 10.1186/s13028-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology. RESULTS Mean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites. CONCLUSIONS Barbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.
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Yalcin S, Kibar Y, Tokas T, Gezginci E, Günal A, Ölcücü MT, Özgök IY, Gözen AS. In Vivo Comparison of "V-Loc 90 Wound Closure Device" With "Vicryl" and "Monocryl" in Regard to Tissue Reaction in a Rabbit Bladder Model. Urology 2018; 116:231.e1-231.e5. [PMID: 29505856 DOI: 10.1016/j.urology.2018.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.
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Affiliation(s)
- Serdar Yalcin
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Yusuf Kibar
- Koru Hospital, Department of Urology, Ankara, Turkey
| | - Theodoros Tokas
- General Hospital Hall i.T., Department of Urology and Andrology, Hall in Tirol, Austria
| | - Elif Gezginci
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Armagan Günal
- Gulhane Training and Research Hospital, Department of Pathology, Ankara, Turkey
| | | | | | - Ali Serdar Gözen
- University of Heidelberg, SLK-Kliniken, Department of Urology, Heilbronn, Germany.
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Gardella B, Dominoni M, Iacobone A, De Silvestri A, Tinelli C, Bogliolo S, Spinillo A. What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation. Gynecol Obstet Invest 2018; 83:521-532. [DOI: 10.1159/000488241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/07/2018] [Indexed: 12/15/2022]
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Zayed MA, Fouda UM, Elsetohy KA, Zayed SM, Hashem AT, Youssef MA. Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 32:710-717. [DOI: 10.1080/14767058.2017.1388368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mohamed A. Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Usama M. Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled A. Elsetohy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereef M. Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed T. Hashem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A. Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Umranikar SA, Ubee SS, Selvan M, Cooke P. Barbed suture tissue closure device in urological surgery – a comprehensive review. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817702315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development and implementation of barbed sutures has transformed the technique of tissue closure with increasing application across multiple surgical disciplines. Changes in design and handling such as the introduction of absorbable and non-absorbable bidirectional barbed sutures reflect an increasing applicability in tissues of varying qualities. We undertook a comprehensive review of available literature to provide an evidence-based rationale for the clinical use of barbed suture tissue closure devices. We summarise uses along with advantages and disadvantages reported across a number of surgical specialties such as urology, orthopaedics, gynaecology and plastic surgery. Tangible benefits noted were faster closure speed, maintenance of suture integrity, improved efficiency in closure, avoidance of knots and possibly a cost-benefit effect. In terms of complications, the barbed sutures compared equally with standard sutures with no significant differences. In conclusion, barbed sutures have demonstrated versatility and safety across surgical specialties and compares favourably with standard sutures. There appears to be an increasing popularity in the use of barbed sutures with clear advantages to both surgeon and patient.
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Affiliation(s)
- Salil A Umranikar
- Department of Urology, University Hospital of North Midlands NHS Trust, UK
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Sarvpreet S Ubee
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Masilamani Selvan
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Peter Cooke
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
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Fouda UM, Elsetohy KA, Elshaer HS. Barbed Versus Conventional Suture: A Randomized Trial for Suturing the Endometrioma Bed After Laparoscopic Excision of Ovarian Endometrioma. J Minim Invasive Gynecol 2016; 23:962-8. [DOI: 10.1016/j.jmig.2016.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
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Zhang Y, Ma D, Li X, Zhang Q. Role of Barbed Sutures in Repairing Uterine Wall Defects in Laparoscopic Myomectomy: A Systemic Review and Meta-Analysis. J Minim Invasive Gynecol 2016; 23:684-91. [PMID: 26997417 DOI: 10.1016/j.jmig.2016.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/27/2022]
Abstract
As an innovative technology barbed sutures have demonstrated clinical and surgical benefits in several specialties. The purpose of this study was to systemically review the available evidence on the application of barbed sutures in repairing the uterine wall defects in laparoscopic myomectomy and to compare with conventional suture in clinical safety and efficacy. Medline, Embase, and Cochrane Database of Systematic Reviews were used for a systematic electronic search of published literature. Studies were selected that evaluate barbed sutures in surgical treatment for patients with benign myomas eligible for laparoscopic myomectomy in comparison with conventional sutures. Depending on the heterogeneity, either a fixed-effects model or random-effects model was used in this meta-analysis. Continuous variable data were showed as standard mean difference (SMD) and weighted mean difference with 95% confidence interval (CI). A total of 7 studies (n = 484) met inclusion criteria. Compared with conventional sutures, barbed sutures demonstrated significant reductions in suturing time (SMD, -1.26; 95% CI, -1.85 to -.67; p < .001), operating time (SMD, -.64; 95% CI, -.83 to -.44; p < .001), intraoperative blood loss (SMD, -.43; 95% CI, -.79 to -.06; p = .021), and postoperative hemoglobin drop (SMD, -.56; 95% CI, -1.01 to -.11; p = .014). The result was numerically lower in the barbed suture group for hospital length of study, although there was no significant difference. This meta-analysis demonstrates clear clinical advantages of time savings and blood loss reduction by using barbed sutures in close uterine wall defects in laparoscopic myomectomy compared with conventional sutures. Those benefits may reduce the surgical difficulty in laparoscopic myomectomy procedures.
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Affiliation(s)
- Yuan Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiong Li
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, China.
| | - Qinghua Zhang
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, China
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Giampaolino P, De Rosa N, Tommaselli GA, Santangelo F, Nappi C, Sansone A, Bifulco G. Comparison of bidirectional barbed suture Stratafix and conventional suture with intracorporeal knots in laparoscopic myomectomy by office transvaginal hydrolaparoscopic follow-up: a preliminary report. Eur J Obstet Gynecol Reprod Biol 2015; 195:146-150. [PMID: 26540594 DOI: 10.1016/j.ejogrb.2015.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/27/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare surgical outcomes of different types of intracorporeal sutures for laparoscopic posterior myomectomy, by a prospective randomized study. STUDY DESIGN Prospective randomized study on 47 patients with single posterior intramural myoma (4-7cm in diameter) undergoing laparoscopic myomectomy. The patients enrolled were divided into two groups, one operated using conventional suture in double strand, and the other with bidirectional barbed suture Stratafix. The main outcome measures were suturing time, peri-operative variables, and post-operative adhesions in both groups. RESULTS The mean operative time was shorter with the Stratafix™ than with the conventional suture (66.3±8.2 vs. 73±8min; p=0.005). Suturing time was significantly shorter in the Stratafix™ than in the control group (8.8±2.4 vs. 15.5±2.8min; p=0.001). Intraoperative bleeding was significantly less in the Stratafix group (p=0.0012). Conversely, there was no statistically significant difference for postoperative adhesions between the two groups (26.7% vs. 21.4% p=0.5). CONCLUSIONS The use of barbed suture may reduce operative time, suturing time, and blood loss. No difference in post operative adhesions was found.
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Affiliation(s)
| | - Nicoletta De Rosa
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | | | - Fabrizia Santangelo
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Carmine Nappi
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Anna Sansone
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
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Uterine myomata: Organ-preserving surgery. Best Pract Res Clin Obstet Gynaecol 2015; 35:30-6. [PMID: 26542930 DOI: 10.1016/j.bpobgyn.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/23/2022]
Abstract
Most women with uterine myoma are asymptomatic and do not require any treatment. However, myoma can also lead to menorrhagia, pressure symptoms, abdominal pain, and infertility. Management of symptomatic women with myoma depends on several factors, including age, desire for fertility, and myoma characteristics. Uterine myoma that distorts the uterine cavity, either submucous myoma or intramural myoma, with a submucous component reduces fertility, and is associated with increased uterine bleeding. The treatment of choice is hysteroscopic myomectomy or abdominal myomectomy, preferably by laparoscopy. Robotic assistance in laparoscopic myomectomy leads to outcomes similar to conventional laparoscopic myomectomy. However, it is expensive. Newer techniques include either laparoscopic or transcervical radiofrequency thermal ablation.
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Api M, Boza A, Cıkman MS, Aker FV, Onenerk M. Comparison of barbed and conventional sutures in adhesion formation and histological features in a rat myomectomy model: randomized single blind controlled trial. Eur J Obstet Gynecol Reprod Biol 2015; 185:121-5. [DOI: 10.1016/j.ejogrb.2014.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
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Peritoneal closure over barbed suture to prevent adhesions: a randomized controlled trial in an animal model. J Minim Invasive Gynecol 2015; 22:619-25. [PMID: 25620215 DOI: 10.1016/j.jmig.2015.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To compare adhesion formation and histological features of peritoneal closure and nonclosure over an intra-abdominally placed barbed suture. DESIGN Single-blind randomized controlled trial (Canadian Task Force Classification I). SETTING Certified animal research facility. SUBJECTS Eight nonpregnant rats. INTERVENTIONS Abdominal cavities were entered via midline incision. Left and right parietal peritoneal surfaces were incised 1.5 cm long separately and stitched with unidirectional barbed suture material (3/0 V-Loc). The parietal peritoneum was approximated over the barbed suture using polypropylene suture material (7/0 Prolene) to embed the barbed suture (peritonization) on one side, and left open on the other side. The side of the barbed suture to be peritonized was allocated at random. On the postoperative day 32, all rats were sacrificed, adhesion formations on each side were macroscopically scored, and histological features were evaluated microscopically. MEASUREMENT AND MAIN RESULTS The median adhesion score was 2.00 (range, 1-4) on operative fields. There was no statistically significant difference in median adhesion score between the peritonized and nonperitonized sides (1.5 vs 2, respectively; p = .13). Microscopically, there were no statistically significant differences in median acute and chronic inflammation scores between the peritonized and nonperitonized sides (p = .58 and p = .45, respectively), but a significantly higher median fibrosis score on the peritonized side (3 vs 1.5, respectively; p = .02). CONCLUSION Based on the results of the present study in a rat model, barbed suture material might be associated with adhesion formation when used intra-abdominally, and these adhesions could not be prevented by peritonization.
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A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy. Int Urogynecol J 2014; 26:649-56. [DOI: 10.1007/s00192-014-2566-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
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23
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Aoki Y, Kikuchi I, Kumakiri J, Kitade M, Shinjo A, Ozaki R, Kawasaki Y, Takeda S. Long unidirectional barbed suturing technique with extracorporeal traction in laparoscopic myomectomy. BMC Surg 2014; 14:84. [PMID: 25345546 PMCID: PMC4217315 DOI: 10.1186/1471-2482-14-84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/17/2014] [Indexed: 11/16/2022] Open
Abstract
Background Myomectomy is now often performed laparoscopically rather than by laparotomy to alleviate the risk of postoperative adhesions and reduce postoperative pain. However, intracorporeal knot-tying under direct laparoscopy is difficult and requires proficiency. We conducted a retrospective study comparing the results of a long unidirectional barbed suturing technique (with V-Loc180 suture) and the results of conventional suturing as applied to laparoscopic myomectomy. Methods In women who underwent laparoscopic myomectomy in our university hospital between January 2011 and April 2013, uninterrupted suturing of 2 or more layers was performed. These women were divided into 2 groups according to the method of suturing: those in whom standard absorbable sutures were used (group P, n =42) and those in whom our suturing technique was used (group V, n =41). Patient characteristics and surgical variables were compared between the 2 groups. Results No significant between-group difference was observed in age (p = .975), body mass index (p = .778), GnRHa administration (p = .059), intraoperative vasopressin dose (p = .364), intraoperative blood loss (73.8 ± 64.1 vs. 59.3 ± 54.0 mL, respectively; p = .199), myoma mass (212.6 ± 133.3 vs. 208.3 ± 198.4 g, respectively; p = .134), ΔHb (p = .517), or postoperative hospital stay (p = .314). Operation time (mean ± SD) was significantly shorter for group V (71.2 ± 22.9 minutes; range, 28.0–110.0 minutes; p < .001) than for group P (94.4 ± 27.2 minutes; range, 53.0–165.0 minutes). No patient required intraoperative transfusion or conversion to laparotomy. Conclusions Our suturing technique exploits the features of unidirectional barbed sutures and can be used in the same way as the conventional method when performing continuous suturing for laparoscopic myomectomy. Our data suggest that operation time can be reduced by as much as 25% with this new technique. Electronic supplementary material The online version of this article (doi:10.1186/1471-2482-14-84) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan.
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Tulandi T, Einarsson JI. The Use of Barbed Suture for Laparoscopic Hysterectomy and Myomectomy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2014; 21:210-6. [DOI: 10.1016/j.jmig.2013.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Einarsson JI, Cohen SL, Gobern JM, Sandberg EM, Hill-Lydecker CI, Wang K, Brown DN. Barbed Versus Standard Suture: A Randomized Trial for Laparoscopic Vaginal Cuff Closure. J Minim Invasive Gynecol 2013; 20:492-8. [DOI: 10.1016/j.jmig.2013.02.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/12/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
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Blikkendaal MD, Twijnstra ARH, Pacquee SCL, Rhemrev JPT, Smeets MJGH, de Kroon CD, Jansen FW. Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. ACTA ACUST UNITED AC 2012; 9:393-400. [PMID: 23144640 PMCID: PMC3491192 DOI: 10.1007/s10397-012-0745-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/06/2012] [Indexed: 11/26/2022]
Abstract
Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH.
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Affiliation(s)
- M. D. Blikkendaal
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - A. R. H. Twijnstra
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - S. C. L. Pacquee
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - J. P. T. Rhemrev
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - M. J. G. H. Smeets
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - C. D. de Kroon
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - F. W. Jansen
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
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EINARSSON JONI, VONNAHME KIMBERLYA, SANDBERG EVELIENM, GRAZUL-BILSKA ANNAT. Barbed compared with standard suture: Effects on cellular composition and proliferation of the healing wound in the ovine uterus. Acta Obstet Gynecol Scand 2012; 91:613-9. [DOI: 10.1111/j.1600-0412.2012.01381.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Angioli R, Plotti F, Montera R, Damiani P, Terranova C, Oronzi I, Luvero D, Scaletta G, Muzii L, Panici PB. A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gynaecol Obstet 2012; 117:220-3. [PMID: 22445426 DOI: 10.1016/j.ijgo.2011.12.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/22/2011] [Accepted: 02/21/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare effectiveness, feasibility, and suturing time required between an absorbable barbed wire (V-Loc) uterine suture and a classic continuous suture with intracorporeal knots among women undergoing laparoscopic myomectomy. METHODS From January 2010 to February 2011, women with single symptomatic intramural myoma were prospectively enrolled in a single-center study at a university hospital in Rome, Italy. A control group with characteristics meeting the criteria for study inclusion was retrospectively identified from the hospital databases. In the prospective group uterine wall defects were closed with V-Loc suture, whereas in the control group they were closed by classical continuous suture with intracorporeal knots. Data were analyzed via Student t test, Mann-Whitney U test, and Fisher exact test. RESULTS The mean operative time was shorter in the V-Loc (51±18.1 min) than in the control (58±17.8 min) group. Suturing time was significantly lower in the V-Loc than in the control (9.9±4.3 versus 15.8±4.7 min; P=0.0004) group. Both intraoperative bleeding and drop in hemoglobin were significantly lower in the V-Loc group (P=0.0076 and P=0.0176, respectively). CONCLUSION Use of a barbed suture may aid surgeons during laparoscopic suturing by reducing operative time, suturing time, and blood loss.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio Medico University of Rome, Rome, Italy
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