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Hafermann J, Silas U, Saunders R. Efficacy and safety of V-Loc ™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1249-1265. [PMID: 38127141 PMCID: PMC10894094 DOI: 10.1007/s00404-023-07291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries. METHODS We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187. RESULTS In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation. CONCLUSION This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.
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Affiliation(s)
- Juliane Hafermann
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany.
| | - Ubong Silas
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany
| | - Rhodri Saunders
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany
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O'Connor RM, Scott ME, Rimel BJ. Vaginal Cuff Dehiscence in Transgender Patients After Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2024; 31:138-146. [PMID: 37925016 PMCID: PMC11129707 DOI: 10.1016/j.jmig.2023.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
STUDY OBJECTIVE To compare rates of vaginal cuff dehiscence (VCD) in transgender patients with cisgender patients after minimally invasive hysterectomy (MIH). DESIGN We performed a single-surgeon, retrospective cohort analysis comparing the rates of VCD in patients undergoing MIH for gender affirmation with other indications (benign, malignant, prophylactic) with our study surgeon between January, 2015, and December, 2021. SETTING Major, urban, academic tertiary care hospital in the United States. PATIENTS 166 patients met inclusion criteria with 49 of those patients undergoing MIH (29.5%) for gender affirmation. Of the remaining 117 patients, 92 (78.6%) underwent MIH for cancer, 15 (12.8%) for prophylaxis, and 10 (8.5%) for benign indications. INTERVENTIONS Not applicable. MEASUREMENTS We assessed included patients for baseline demographics, presence of risk factors for VCD, details of index hysterectomy, and details of cuff dehiscence events. MAIN RESULTS Transgender patients tended to be younger at the time of surgery, but demographics were otherwise similar between both groups. Most transgender patients (n = 36, 73.5%) had both ovaries removed at the time of hysterectomy, 100% were on testosterone therapy pre- and postoperatively, and none used supplementary estrogen. Three of the 49 transgender patients (6.1%) experienced postoperative dehiscence of the vaginal cuff compared with 2 of the 117 cisgender patients (1.7%). This failed to reach statistical significance; however, our descriptive analysis showed that all cases of dehiscence in the cisgender group had identifiable precipitating factors (i.e., trauma). By comparison, all cases of dehiscence in the transgender group were spontaneous with few identifiable risk factors. CONCLUSION Transgender patients undergoing MIH may be at increased risk of VCD, although the rarity of this surgical complication precluded determination of statistical significance in our data set. We propose testosterone exposure as a possible risk factor for VCD, although we cannot exclude other factors, such as young age, as drivers of VCD in this population. Future studies of biospecimens are needed to evaluate for cellular differences in these patients.
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Affiliation(s)
- Reed M O'Connor
- Department of Obstetrics and Gynecology (Dr. O'Connor), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Marla E Scott
- Division of Gynecologic Oncology (Drs. Scott and Rimel)
| | - B J Rimel
- Division of Gynecologic Oncology (Drs. Scott and Rimel).
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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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Fermin O, Delgado A, Sarkar P, Chern JY, Wenham R, Hoffman MS. Vaginal Evisceration Subsequent to Hysterectomy at a Major Cancer Center. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Oriana Fermin
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Papri Sarkar
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Jing-Yi Chern
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Robert Wenham
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mitchel S. Hoffman
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Leonard S, Opfermann J, Uebele N, Carroll L, Walter R, Bayne C, Ge J, Krieger A. Vaginal Cuff Closure With Dual-Arm Robot and Near-Infrared Fluorescent Sutures. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2021; 3:762-772. [PMID: 36970042 PMCID: PMC10038549 DOI: 10.1109/tmrb.2021.3097415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper presents a dual-arm suturing robot. We extend the Smart Tissue Autonomous Robot (STAR) with a second robot manipulator, whose purpose is to manage loose suture thread, a task that was previously executed by a human assistant. We also introduce novel near-infrared fluorescent (NIRF) sutures that are automatically segmented and delimit the boundaries of the suturing task. During ex-vivo experiments of porcine models, our results demonstrate that this new system is capable of outperforming human surgeons in all but one metric for the task of vaginal cuff closure (porcine model) and is more consistent in every aspect of the task. We also present results to demonstrate that the system can perform a vaginal cuff closure during an in-vivo experiment (porcine model).
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Affiliation(s)
- Simon Leonard
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Justin Opfermann
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lydia Carroll
- Rotary Mission Systems, Lockheed Martin, Mount Laurel, NJ, USA
| | | | | | - Jiawei Ge
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
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Incidence and Prevention of Vaginal Cuff Dehiscence after Laparoscopic and Robotic Hysterectomy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:710-720. [PMID: 33348012 DOI: 10.1016/j.jmig.2020.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Vaginal cuff dehiscence, a severe and potentially detrimental complication, has significantly increased after the introduction of endoscopic hysterectomy. The aim of this systematic review and meta-analysis of the available literature was to identify the incidence of, and possible strategies to prevent, this complication after total laparoscopic hysterectomy and total robotic hysterectomy. DATA SOURCES PubMed, ClinicalTrials.gov, Scopus, and Web of Science databases were systematically queried to identify all articles reporting either laparoscopic or robot-assisted hysterectomies for benign indications in which vaginal dehiscence was reported as an outcome. Reference lists of the identified studies were manually searched. Only papers written in English were considered. METHODS OF STUDY SELECTION The Population, Intervention, Comparison, and Outcome framework for the review included (1) population of interest: women who underwent conventional and robot-assisted laparoscopic hysterectomy; (2) interventions: possible methods to prevent vaginal dehiscence; (3) comparison: experimental strategies vs standard treatment or alternative strategy for each item of intervention; and (4) outcome: rate of vaginal dehiscence. Series of subtotal hysterectomies and radical hysterectomies in addition to reports that combined both benign and malignant cases were excluded. The meta-analysis was performed using RevMan version 5.4.1 (Cochrane Training, London, United Kingdom). Two independent reviewers identified all reports comparing 2 or more possible strategies to prevent vaginal dehiscence. TABULATION, INTEGRATION, AND RESULTS A total of 460 articles were identified. Of these, 20 (6 randomized, 2 prospective, and 12 retrospective) studies were included in this review for a total of 19 392 patients. The incidence of vaginal dehiscence after total laparoscopic hysterectomy ranged between 0.64% and 1.35%. Robotic hysterectomy was associated with a risk of vaginal dehiscence of approximately 1.64%. No study compared early vs delayed resumption of coital activity nor analyzed the role of training in laparoscopic suturing. No study specifically assessed the impact of electrosurgery on the risk of vaginal dehiscence in endoscopic hysterectomies for benign indications. Double-layer and reinforced sutures did not decrease the risk of dehiscence. Barbed sutures reduced the risk of separation compared with nonbarbed closure (0.4% [4/1108] vs 2% [22/1097]; odds ratio [OR] 0.25; 95% confidence interval [CI], 0.11-0.57). However, these data came mainly from retrospective series. Excluding studies on the use of self-anchoring sutures during robotic hysterectomy, there was no significant difference in the risk of dehiscence between barbed and nonbarbed sutures (0.5% [4/890] vs 1.4% [181/776]; OR 0.38; 95% CI, 0.13-1.10). Transvaginal suture of the vault at the end of an endoscopic hysterectomy seemed to increase the risk of dehiscence when compared with laparoscopic closure (2.3% [23/1002] vs 1.16% [11/944]; OR 1.97; 95% CI, 1.00-3.88). CONCLUSION There is a paucity of high-quality papers evaluating vaginal dehiscence and possible prevention strategies in the current literature. Only 2 effective strategies have been identified in reducing the risk for this complication: the use of barbed sutures and the adoption of a laparoscopic approach to close the vaginal cuff. When restricting the analysis only to laparoscopic cases, the use of barbed sutures does not protect against vaginal cuff separation.
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Kim J, Eom HJ, Shin H, Jeong SY, Kim MS, Yoon HS, In CH, Kim BG, Bae DS, Lee JW. In Vivo Comparison of MONOFIX, A Novel Barbed Suture with a Triangular Stopper, with Pre-existing Products in a Porcine Model. J Minim Invasive Gynecol 2019; 27:473-481. [PMID: 30959198 DOI: 10.1016/j.jmig.2019.04.005] [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: 01/17/2019] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE MONOFIX, a new absorbable barbed suture device, has a triangular stopper at the end to hold the suture to the tissue without hooking the looped end or knotting. The aim of this study was to compare the biomechanical strength and histologic features of MONOFIX with other barbed suture devices using a porcine model. DESIGN Well-designed, controlled trial without randomization. SETTING Animal laboratory in university hospital. SUBJECTS Sixteen, 60-kg, mature female domestic pigs (skin closure group) and 5, 60-kg, mature female domestic pigs (fascial closure group). INTERVENTIONS In the skin closure group, 3-0 MONOFIX versus 2 widely used 3-0 absorbable barbed sutures (3-0 V-Loc 180 or Stratafix). In the fascial closure group, 2-0 MONOFIX versus 1 widely used 2-0 absorbable barbed sutures (2-0 Stratafix). MEASUREMENTS AND MAIN RESULTS In the skin closure group, the biomechanical wound strength of skin sutured with size 3-0 MONOFIX, V-Loc 180, or Stratafix was evaluated by postoperative day assessment (days 0, 3, 7, 14, and 28). In the fascial closure group, pigs underwent 2 paramedian incisions and were sutured with 2-0 MONOFIX or with 2-0 Stratafix to evaluate histologic reaction. At 6 weeks the tissues around the suture line were excised and microscopically evaluated. The biomechanical strength of the MONOFIX had similar tissue tensile strength compared with the control, regardless of postoperative day. In the fascial closure model, there was no significant difference in the average tissue reaction score between MONOFIX and Stratafix (1.2 ± .3 vs 1.3 ± .3, p = .478). CONCLUSION This study demonstrated that MONOFIX has equivalent tensile strength and histologic reaction when compared with commonly used barbed suture devices. Accordingly, this preclinical study suggests that the use of MONOFIX is a safe alternative to other barbed suture devices.
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Affiliation(s)
- Jihye Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Hye Jin Eom
- Samyang Biopharmaceuticals Corporation, Sungnam-si, Korea, and Medical Device Plant (Ms. Eom), Samyang Biopharmaceuticals, Daejeon, Korea
| | - Hyeongchan Shin
- Pathology and Translational Genomics (Dr. Shin), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Young Jeong
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Myeong Seon Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | | | | | - Byoung-Gie Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Duk-Soo Bae
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Jeong-Won Lee
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee).
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Misirlioglu S, Boza A, Arslan T, Urman B, Taskiran C. Unidirectional barbed suture for vaginal cuff closure without backward stitch in total laparoscopic hysterectomy. J Obstet Gynaecol Res 2018; 44:1793-1799. [PMID: 30019797 DOI: 10.1111/jog.13696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/13/2018] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the safety and efficacy of unidirectional barbed suture technique for vaginal cuff closure in total laparoscopic hysterectomy (TLH). METHODS 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. RESULTS 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%). CONCLUSION 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.
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Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Aysen Boza
- Women's Health Center, VKF American Hospital, Istanbul, Turkey
| | - Tonguc Arslan
- Women's Health Center, VKF American Hospital, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF American Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Women's Health Center, VKF American Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
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Uccella S, Malzoni M, Cromi A, Seracchioli R, Ciravolo G, Fanfani F, Shakir F, Gueli Alletti S, Legge F, Berretta R, Corrado G, Casarella L, Donarini P, Zanello M, Perrone E, Gisone B, Vizza E, Scambia G, Ghezzi F. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018; 218:500.e1-500.e13. [PMID: 29410107 DOI: 10.1016/j.ajog.2018.01.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vaginal cuff dehiscence following hysterectomy is considered an infrequent but potentially devastating complication. Different possible techniques for cuff closure have been proposed to reduce this threatening adverse event. OBJECTIVE The aim of the present randomized study was to compare laparoscopic and transvaginal suture of the vaginal vault at the end of a total laparoscopic hysterectomy, in terms of incidence of vaginal dehiscence and vaginal cuff complications. Factors associated with vaginal dehiscence were also analyzed. This article presents the results of the interim analysis of the trial. STUDY DESIGN Patients undergoing total laparoscopic hysterectomy for benign indications were randomized at the time of colpotomy to receive vaginal closure through transvaginal vs laparoscopic approach using a 1:1 ratio. Allocation concealment was obtained using a password-protected randomization database. Monopolar energy for colpotomy was set at 60W. Vaginal closure was performed with a single-layer running braided and coated 0-polyglactin suture. In all cases an attempt was performed to include the posterior peritoneum in the suture. Laparoscopic knots were tied intracorporeally. All patients were scheduled for a postoperative follow-up visit 3 months after surgery, to detect possible vaginal cuff complications. Univariate and multivariable analyses were performed to identify independent predictors of vaginal cuff dehiscence after total laparoscopic hysterectomy. RESULTS After enrollment of 1408 patients, a prespecified interim analysis was conducted. Thirteen (0.9%) women did not undergo the postoperative assessment and were excluded. Baseline characteristics of the 1395 patients included (695 in the transvaginal group and 700 in the laparoscopic group) were similar between groups. Patients in the transvaginal group had a significantly higher incidence of vaginal dehiscence (2.7% vs 1%; odds ratio, 2.78; 95% confidence interval, 1.16-6.63; P = .01) and of any cuff complication (9.8% vs 4.7%; odds ratio, 2.19; 95% confidence interval, 1.43-3.37; P = .0003). Based on these findings, the data monitoring committee recommended that the trial be terminated early. After multivariable analysis, transvaginal closure of the vault was independently associated with a higher incidence of vaginal dehiscence and any vaginal complication; premenopausal status and smoking habit were independently associated with a higher risk of dehiscence. CONCLUSION Laparoscopic closure of the vaginal cuff at the end of total laparoscopic hysterectomy is associated with a significant reduction of vaginal dehiscence, any cuff complication, vaginal bleeding, vaginal cuff hematoma, postoperative infection, need for vaginal resuture, and reintervention.
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Affiliation(s)
- Stefano Uccella
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy; Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
| | - Mario Malzoni
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Renato Seracchioli
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Ciravolo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Fevzi Shakir
- Department of Obstetrics and Gynecology, Royal Free Hospital, London, United Kingdom
| | - Salvatore Gueli Alletti
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Francesco Legge
- Division of Gynecology, Department of Obstetrics and Gynecology, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Lucia Casarella
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Paolo Donarini
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Margherita Zanello
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuele Perrone
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
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Bracale U, Merola G, Cabras F, Andreuccetti J, Corcione F, Pignata G. The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study. Surg Innov 2018; 25:267-273. [DOI: 10.1177/1553350618765871] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. A totally laparoscopic right colectomy could be perceived as a more challenging procedure over a laparoscopic-assisted right colectomy owing to the difficulty of intracorporeal anastomosis and the closure of the enterotomy. The aim of this study is to evaluate the safety and efficacy of the barbed auto-locking absorbable suture for the closure of an anastomotic stapler-access enterotomy during a totally laparoscopic right colectomy. Methods. From January 2010 to April 2016, data from patients who had undergone a laparoscopic right colectomy in 2 different departments of 2 institutions (the Department of General and Minimally Invasive Surgery, San Camillo Hospital in Trento and the Department of Surgical Specialties and Nephrology, University Federico II in Naples) were retrospectively analyzed. We compared the data of patients in whom the stapler-access enterotomy was closed through a conventional absorbable suture (Group A), with the data of patients in whom a stapler-access enterotomy was closed through a V-Loc 180 suture (Group B). Biometric features and intraoperative and postoperative data were collected and analyzed. Results. The 2 groups (Group A: 40 patients; Group B: 40 patients) were comparable for biometric features and postoperative outcomes. The anastomosing time was lower in Group B. A statistically significant difference was noted in the mean operative time between Groups A and B (Group A = 134.92 ± 34.17; Group B = 120.92 ± 23.27, P = .035). Only one anastomotic leakage per group was recorded, each treated with an anastomosis redo. During the reoperations, we find in both groups an intact stapler-access enterotomy. Conclusion. On retrospective analysis, barbed suture appears to be safe and efficient for closure of the stapler-access enterotomy during totally laparoscopic right colectomy.
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Affiliation(s)
| | - Giovanni Merola
- University Federico II of Naples, Naples, Italy
- San Camillo Hospital, Trento, Italy
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Karacan T, Ozyurek E, Usta T, Odacilar E, Hanli U, Kovalak E, Dayan H. Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. J OBSTET GYNAECOL 2018; 38:842-847. [PMID: 29577776 DOI: 10.1080/01443615.2017.1416597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p < .05). V-Loc™ 180 unidirectional barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications.
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Affiliation(s)
- Tolga Karacan
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Eser Ozyurek
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Taner Usta
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Eylem Odacilar
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Ulviye Hanli
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Ebru Kovalak
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Huseyin Dayan
- b Department of Obstetrics and Gynaecology , Arnavutkoy Government Hospital , Istanbul , Turkey
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Kim SM, Baek JM, Song JY, Lee SJ, Park EK, Kim CJ, Lee YS. The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy. Arch Gynecol Obstet 2017; 297:691-697. [PMID: 29289989 DOI: 10.1007/s00404-017-4637-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure. METHODS A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups. RESULTS A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P = 0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate. CONCLUSION Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.
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Affiliation(s)
- Su Mi Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jong Min Baek
- Department of General Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Eun Kyung Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Seok Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Smith K, Caceres A. Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials. Cureus 2017; 9:e1766. [PMID: 29234570 PMCID: PMC5724812 DOI: 10.7759/cureus.1766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions. The development of minimally invasive surgery has transformed this procedure, resulting in improved outcomes, superior cosmesis, and quicker return to normal function. Vaginal cuff closure is a critical component of hysterectomy, with many variations in surgical technique and materials. This review provides an overview of intracorporeal suturing and knot-tying techniques at the level of a junior resident in obstetrics and gynecology and describes several validated models that have been developed to test resident skill level in vaginal cuff closure. We also provide a review of the literature regarding vaginal cuff closure techniques and suture materials, including knotless barbed sutures. Finally, a brief discussion of single-site surgery, the latest development in minimally invasive hysterectomy, will be provided. We hope to provide a better understanding of vaginal cuff closure for residents in the field of obstetrics and gynecology.
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Aydogmus H, Aydoğmuş S, Gençdal S, Kelekçi S. Cuff Closure by Vaginal Route in TLH: Case Series and Review of Literature. J Clin Diagn Res 2017; 11:QD01-QD03. [PMID: 28511460 DOI: 10.7860/jcdr/2017/25056.9447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/13/2017] [Indexed: 11/24/2022]
Abstract
Total Laparoscopic Hysterectomy (TLH) represents one of the most performed gynaecological procedures nowadays. The closure of the vaginal cuff is the most diffucult part of TLH because of the difficulty of laparoscopic suturing techniques. Our aim was to evaluate the efficacy and safety of vaginal cuff closure by vaginal route on patients submitted to TLH. During the period between January 2013 to December 2015 total number of 64 laparoscopic hysterectomy were performed in our clinic. TLH and vaginal vault closure was performed as described by Ghezzi for all patients. The length of cuff closure time and the frequency of vaginal cuff-related complications were measured. Mean age was 48.1 (38-71) years, mean parity was 2.6 (1-9). Most ranked indications for hysterectomy were abnormal uterine bleeding and symptomatic leiomyoma. Average cuff closure time was 6 (2-17) minute. In average 24 (2-36) month follow-up there were no vaginal vault dehiscence. Transvaginal vaginal cuff closure seems to be safe, easy and effective for total vaginal hysterectomy. Using vaginal route can significantly reduce the length of closure time. This technique has comparable complication rates with endoscopic suturing techniques.
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Affiliation(s)
- Huseyin Aydogmus
- Lecturer, Department of Obstetrics and Gynaecology, İzmir Katip Çelebi University, Atatürk Research and Training Hospital, İzmir, Narlıdere, Turkey
| | - Serpil Aydoğmuş
- Associate Professor, Department of Obstetrics and Gynaecology, İzmir Katip Çelebi University, Atatürk Research and Training Hospital, İzmir, Narlıdere, Turkey
| | - Servet Gençdal
- Lecturer, Department of Obstetrics and Gynaecology, İzmir Katip Çelebi University, Atatürk Research and Training Hospital, İzmir, Narlıdere, Turkey
| | - Sefa Kelekçi
- Professor, Department of Obstetrics and Gynaecology, İzmir Katip Çelebi University, School of Medicine, İzmir, Karabağlar, Turkey
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Tsukada T, Kaji M, Kinoshita J, Shimizu K. Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures. JSLS 2017; 20:JSLS.2016.00023. [PMID: 27493467 PMCID: PMC4949351 DOI: 10.4293/jsls.2016.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background and Objectives: Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes. Methods: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection. Results: In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted. Conclusion: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.
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Affiliation(s)
- Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Jun Kinoshita
- Department of Gastroenterologic Surgery, Kanazawa University, Department of Gastroenterologic Surgery, Kanazawa University, Ishikawa, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
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Robotic repair of vaginal evisceration after hysterectomy and the role of intraoperative near-infrared fluorescence imaging. J Robot Surg 2017; 11:383-386. [PMID: 28243822 DOI: 10.1007/s11701-017-0688-y] [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: 01/07/2017] [Accepted: 02/19/2017] [Indexed: 10/20/2022]
Abstract
Vaginal evisceration of the small bowel is a rare and potentially life-threatening complication after hysterectomy. This complication requires prompt surgical management and methods of surgical repair include abdominal, vaginal or laparoscopic approaches. We report the first case of robotic approach for repair of vaginal evisceration and intraoperative use of near-infrared fluorescence imaging for the assessment of bowel perfusion in a 63-year-old postmenopausal woman with a history of robotic hysterectomy for cervix cancer. This case demonstrates the safety and feasibility of robotic surgery and the advantage of using intraoperative near-infrared fluorescence imaging for bowel perfusion, a critical factor for surgical decision-making.
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Reply to: #00279 "Dramatically reduced incidence of vaginal cuff dehiscence in gynecologic patients undergoing endoscopic closure with barbed sutures: A retrospective cohort study". Int J Surg 2017; 41:209. [PMID: 28235669 DOI: 10.1016/j.ijsu.2017.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/15/2017] [Indexed: 11/22/2022]
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Picerno T, Sloan NL, Escobar P, Ramirez PT. Bowel injury in robotic gynecologic surgery: risk factors and management options. A systematic review. Am J Obstet Gynecol 2017; 216:10-26. [PMID: 27640938 DOI: 10.1016/j.ajog.2016.08.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to analyze the published literature on bowel injuries in patients undergoing gynecologic robotic surgery with the aim to determine its incidence, predisposing factors, and treatment options. DATA SOURCES Studies included in this analysis were identified by searching PubMed Central, OVID Medline, EMBASE, Cochrane, and ClinicalTrials.gov databases. References for all studies were also reviewed. Time frame for data analysis spanned from November 2001 through December 2014. STUDY ELIGIBILITY CRITERIA All English-language studies reporting the incidence of bowel injury or complications during robotic gynecologic surgery were included. Studies with data duplication, not in English, case reports, or studies that did not explicitly define bowel injury incidence were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS The Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies were used to complete the systematic review with the exception of scoring study quality and a single primary reviewer. RESULTS In all, 370 full-text articles were reviewed and 144 met the inclusion criteria. There were 84 bowel injuries recorded in 13,444 patients for an incidence of 1 in 160 (0.62%; 95% confidence interval, 0.50-0.76%). There were no significant differences in incidence of bowel injury by procedure type. The anatomic location of injury, etiology, and management were rarely reported. Of the bowel injuries, 87% were recognized intraoperatively and the majority (58%) managed via a minimally invasive approach. Of 13,444 patients, 3 (0.02%) (95% confidence interval, 0.01-0.07%) died in the immediate postoperative period and no deaths were a result of a bowel injury. CONCLUSION The overall incidence of bowel injury in robotic-assisted gynecologic surgery is 1 in 160. When the location of bowel injuries were specified, they most commonly occurred in the colon and rectum and most were managed via a minimally invasive approach.
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Cong L, Li C, Wei B, Zhan L, Wang W, Xu Y. V-Loc™ 180 suture in total laparoscopic hysterectomy: a retrospective study comparing Polysorb to barbed suture used for vaginal cuff closure. Eur J Obstet Gynecol Reprod Biol 2016; 207:18-22. [DOI: 10.1016/j.ejogrb.2016.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/26/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022]
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Tsafrir Z, Palmer M, Dahlman M, Nawfal AK, Aoun J, Taylor A, Fisher J, Theoharis E, Eisenstein D. Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 210:7-12. [PMID: 27923167 DOI: 10.1016/j.ejogrb.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/14/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. STUDY DESIGN Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty® (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding. RESULTS The study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed. CONCLUSIONS The type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons' preference and cost effectiveness.
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Affiliation(s)
- Ziv Tsafrir
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA; The Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel- Aviv, Israel.
| | - Matthew Palmer
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Marisa Dahlman
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - A Karim Nawfal
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Joelle Aoun
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Andrew Taylor
- Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Jay Fisher
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Evan Theoharis
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - David Eisenstein
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
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Tillmanns TD, Mabe A, Ulm MA, Lee D, Lowe P, Kumar S. Vaginal Cuff Closure in Robotic Hysterectomy: A Randomized Controlled Trial Comparing Barbed Versus Standard Suture. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Adam Mabe
- Division of Gynecologic Oncology, West Cancer Center, Memphis, TN
| | - Michael A. Ulm
- Division of Gynecologic Oncology, West Cancer Center, Memphis, TN
| | - Daniel Lee
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Memphis, TN
| | - Patrick Lowe
- Division of Gynecologic Oncology, Advocate Christ Medical Center/University of Illinois-Chicago College of Medicine, Chicago, IL
| | - Saurabh Kumar
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Memphis, TN
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Brown DN, Gobern JM. Unidirectional Barbed Suture for Vaginal-Cuff Closure in Laparoscopic and Robotic Hysterectomy. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Douglas N. Brown
- Division of Minimally Invasive Gynecologic Surgery, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Joseph M. Gobern
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
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Lee SW, Kawai M, Tashiro K, Nomura E, Tokuhara T, Kawashima S, Tanaka R, Uchiyama K. Laparoscopic gastrointestinal anastomoses using knotless barbed absorbable sutures are safe and reproducible: a single-center experience with 242 patients. Jpn J Clin Oncol 2016; 46:329-35. [PMID: 26819279 DOI: 10.1093/jjco/hyv212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/28/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Intracorporeal reconstruction of the digestive tract is technically challenging. The V-Loc 180 wound closure device (Covidien) is a self-anchoring unidirectional barbed suture that obviates the need for knot tying. The aim of this prospective cohort study was to investigate the use of the novel suture in gastrointestinal enterotomy closure. METHODS The subjects comprised patients with malignant disease who were scheduled to undergo laparoscopic gastrectomy with curative intent. The barbed suture was used to close the entry hole for the linear stapler during intracorporeal reconstruction following laparoscopic gastric resection. The primary endpoint was the proportion of patients who developed anastomotic leakage at the site where the barbed suture was applied. RESULTS Between July 2012 and March 2015, 242 patients were enrolled. Of 362 anastomoses, the enterotomy hole at 256 sites was closed using the barbed suture. These 256 sites consisted of 95 gastroduodenostomies, 25 gastrogastrostomies, 13 gastrojejunostomies, 90 jejunojejunostomies, 17 esophagojejunostomies and 16 primary closures of the stomach following local gastric resection. There were no anastomosis-related complications, conversion to usual sutures, mechanical closure of the entry hole and reoperation due to adhesive obstructions or mortality over a median follow-up period of 17.8 months. CONCLUSIONS The use of the unidirectional barbed absorbable suture for gastrointestinal closure is safe and effective in laparoscopic gastrectomy.
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Affiliation(s)
- Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Masaru Kawai
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Keitaro Tashiro
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Eiji Nomura
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Takaya Tokuhara
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Satoshi Kawashima
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
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Fernandez LC, Toriz A, Hernandez J, Sanchez N, Linares E, Zenteno M, Cuendis A, Olivares J, Guerrero G, Cervantes CF. Knotless choledochorraphy with barbed suture, safe and feasible. Surg Endosc 2015; 30:3630-5. [PMID: 26541731 DOI: 10.1007/s00464-015-4620-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE). INTRODUCTION LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses. METHODS Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded. RESULTS Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death. CONCLUSION The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.
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Affiliation(s)
- Luis C Fernandez
- Hospital General Zona Norte, Puebla, Mexico. .,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico.
| | - Augusto Toriz
- Hospital General Zona Norte, Puebla, Mexico.,Hospital General ISSSTE, Puebla, Mexico
| | | | | | | | | | - Adolfo Cuendis
- Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico
| | | | | | - Cesar F Cervantes
- Hospital General ISSSTE, Puebla, Mexico.,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico
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Iavazzo C, Mamais I, Gkegkes ID. The Role of Knotless Barbed Suture in Gynecologic Surgery. Surg Innov 2015; 22:528-539. [DOI: 10.1177/1553350614554235] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant ( P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.
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Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2015; 292:489-97. [DOI: 10.1007/s00404-015-3653-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/05/2015] [Indexed: 12/26/2022]
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Sinha R, Sanjay M, Rupa B, Kumari S. Robotic surgery in gynecology. J Minim Access Surg 2015; 11:50-9. [PMID: 25598600 PMCID: PMC4290120 DOI: 10.4103/0972-9941.147690] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 01/05/2023] Open
Abstract
FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over.
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Affiliation(s)
- Rooma Sinha
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Madhumati Sanjay
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - B Rupa
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Samita Kumari
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
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Barbed Suture vs Traditional Suture in Single-Port Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2014; 21:825-9. [DOI: 10.1016/j.jmig.2014.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 12/16/2022]
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Unidirectional barbed suture versus interrupted vicryl suture in vaginal cuff healing during robotic-assisted laparoscopic hysterectomy. J Robot Surg 2014; 8:201-5. [PMID: 27637678 DOI: 10.1007/s11701-014-0451-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
This study examined the performance of unidirectional barbed suture versus polyglactin 910 with respect to vaginal cuff healing in robotic-assisted total laparoscopic hysterectomy (RATLH). This was a retrospective cohort study of 93 patients who underwent RATLH in a teaching hospital from July 2008 to June 2012. In the first 44 patients, the vaginal cuff was closed by interrupted polyglactin (Vicryl) 2-0 suture. In the following 49 patients, unidirectional barbed suture (V-loc) in a running fashion was used for cuff closure. Patients were seen 2 and 6 weeks postoperatively to evaluate cuff healing. Age, tobacco use, hemoglobin, deliveries, uterine weight, menopause, steroid use, underlying health problems, and concomitant procedures were found not to be significantly different between the two groups. There was one cuff dehiscence in the unidirectional barbed suture group and none in the interrupted polyglactin group (P > 0.05). The mean cuff healing time (8.5 vs. 7.7 weeks), incidence of cuff cellulitis (4.6 vs. 4.1 %), and postoperative bleeding (22.7 vs. 14.3 %) were not statistically significantly different between polyglactin and barbed suture closures, respectively (P > 0.05). However, polyglactin suture was associated with greater presence of granulation tissue than barbed suture (27.3 vs. 8.2 %, odds ratio = 3.34, P < 0.05). Unidirectional barbed suture cases were associated with shorter total operative times (220.2 vs. 272.8 min) and less estimated blood loss (164.8 vs. 274.9 ml); however, cuff closure times were not specifically measured. In our study, unidirectional barbed suture was identified as possibly superior to polyglactin cuff closure because of less observed granulation tissue, shorter operative duration, and lower estimated blood loss. However, there was no statistical difference in cuff healing time, cuff dehiscence, cellulitis, or postoperative bleeding between the two groups. A prospective randomized trial would be necessary to confirm these findings.
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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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Borahay MA, Oge T, Walsh TM, Patel PR, Rodriguez AM, Kilic GS. Outcomes of robotic sacrocolpopexy using barbed delayed absorbable sutures. J Minim Invasive Gynecol 2013; 21:412-6. [PMID: 24263027 DOI: 10.1016/j.jmig.2013.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE To evaluate 1-year outcomes of robotic sacrocolpopexy (RSC) for pelvic organ prolapse using barbed delayed absorbable sutures. DESIGN Retrospective cohort study (Class II-3). SETTINGS University-based hospital in Southeast Texas. PATIENTS Patients with symptomatic apical pelvic organ prolapse who underwent RSC using barbed delayed absorbable sutures between January 2011 and August 2012. Patients were examined postoperatively at least twice (after 6 weeks and 1 year). INTERVENTIONS RSC procedure. MEASUREMENTS AND MAIN RESULTS The study included a total of 20 patients, of them 15 had grades 3 or 4 whereas 5 had grade 2 apical defects according to the Baden-Walker classification system. Fourteen patients (70%) underwent concomitant hysterectomy while 9 (45%) underwent concomitant anti-incontinence surgery. Mesh suturing times were 46.9 ± 12.6 and 20.5 ± 9.3 minutes in the first 10 versus the last 10 cases, respectively (p < .001). The mean follow-up duration was 17.3 months (range, 12-24 months). There were no recurrences of apical defects or mesh/suture exposure/erosion. However, 1 patient developed a grade 2 cystocele, and another developed new-onset urinary incontinence, both after 1 year. A third patient's urine leakage did not improve postoperatively. Lastly, a fourth patient developed port site incisional hernia and underwent repair 5 months later. CONCLUSION Our study suggests that barbed delayed absorbable sutures are safe and effective in RCS procedures over 1 year. Larger, comparative, and randomized trials are recommended for definitive conclusions.
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Affiliation(s)
- Mostafa A Borahay
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Tufan Oge
- Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Teresa M Walsh
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Pooja R Patel
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Ana M Rodriguez
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Gokhan Sami Kilic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas.
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Salminen HJ, Tan WS, Jayne DG. Three cases of small bowel obstruction after laparoscopic ventral rectopexy using the V-Loc® suture. Tech Coloproctol 2013; 18:601-2. [DOI: 10.1007/s10151-013-1074-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
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