Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta‐analysis

Abstract

As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = -8.52, 95% confidence interval (CI) = -12.60 to -4.43, p < 0.0001] and length of hospital stay (MD = -0.96, 95% CI = -1.80 to -0.11, p = 0.03) were significantly shorter in the barbed group. Results of continence rate varied according to different studies. Subgroup analysis by type of MIRP suggested that patients who underwent barbed suture during robot-assisted surgeries had a shorter hospital stay (MD = -1.13, 95% CI = -1.82 to -0.45, p = 0.001). During the laparoscopic surgery, patients in the barbed suture group had fewer postoperative complications [odds ratio = 0.29, 95% CI = 0.08-0.98, p = 0.05). However, more evidence is needed to validate this state-of-the-art technology.

Barbed vs conventional suture at cesarean delivery: A systematic review and meta‐analysis

“…In addition to a reduction in operative time at gynecological surgeries, there are emerging data on other benefits and their successful application to minimally invasive urological and gastrointestinal surgeries. [15][16][17][18][19] The results of cosmesis after dermal closure with barbed sutures during cesarean were documented as non-inferior to the conventional sutures in the one trial that was included. 12 Comparable cosmetic outcomes have been documented with their use for dermal closure in benign gynecological surgeries; however, the patient satisfaction rate with the use of barbed sutures was significantly higher than with staples (70.12 ± 20.93 vs 50.56 ± 17.46, P < .001).…”

Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

“…After further docking of Da Vinci Xi ® Surgical System, a distal ileal segment is mobilized to reach down the urethral stump. Using a 35 or 45 cm bidirectional barbed suture 3/0 (Filbloc ® Assut, Europe) as a first step we stitch the Denonvilliers Fascia (DF) with both needles, as performed during urethro-vesical anastomosis of radical prostatectomy (RP) (21)(22)(23). Using the left needles, the DF is gently transposed to the fibrous part of the sphincter with to bites from left to right.…”

The application of barbed suture during the partial nephrectomy may modify perioperative results: a systematic review and meta-analysis

“…Initiated in 1964 [9], this approach has been first reported in gynaecological and plastic surgery previously [10]. And then some systematic reviews, in terms of radical prostatectomy [11–13], have confirmed equivalence of biocompatibility and tensile strength of knotless barbed suture compared to conventional sutures in urological field [14, 15].…”