Unidirectional Barbed Suture Versus Polyglactin 910 Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy

Abstract

Introduction and objective Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-Loc TM 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy. Methods A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia. Results Demographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups. Conclusions The unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

“…3 Pooled estimates of suture time [min] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: 8 , 9 , 26 , 29 – 31 , 37 , 40 , 44 , 47 , 49 …”

Prevention and management of vaginal cuff dehiscence: an updated review

“…Despite the estimated rates of VCD being higher for TLH, including robotic-assisted TLH (RATLH), there are clear benefits to minimally invasive hysterectomies – decreased perioperative complications, decreased blood loss, decreased pain, faster recovery, shorter hospitalization time, and improved patient satisfaction [5,20 ▪ ,21 ▪ ,22 ▪ ]. As VCD is rare overall, the most minimally invasive approach appropriate for the patient should be the chosen method.…”

“…A large systemic review and meta-analysis found that barbed suture decreased the risk for VCD in TLH and RATLH but a sub-analysis looking only at TLH did not find a difference in VCD rate between barbed suture and traditional absorbable suture [3 ▪▪ ]. Several studies, including a systemic review and meta-analysis of 11 studies, showed that there was no significant difference in VCD rate when comparing absorbable barbed, traditional absorbable, and/or permanent suture [3 ▪▪ ,6 ▪ ,18,21 ▪ ,32–34]. With this mixed information, surgeons should use the appropriate suture they are most comfortable with.…”

“…With this mixed information, surgeons should use the appropriate suture they are most comfortable with. Although it has not been shown to be superior, barbed suture has the benefit of being self-retaining and knotless and has been shown to decrease vaginal cuff closure time [6 ▪ ,21 ▪ ,31,34]. On the downside, barbed suture is more expensive to use and may not be available in low-resource settings [21 ▪ ,32].…”

“…Although it has not been shown to be superior, barbed suture has the benefit of being self-retaining and knotless and has been shown to decrease vaginal cuff closure time [6 ▪ ,21 ▪ ,31,34]. On the downside, barbed suture is more expensive to use and may not be available in low-resource settings [21 ▪ ,32]. Whenever choosing a suture, the surgeon should always consider options that minimize bacterial growth, cause little tissue reactivity, and maintain appropriate tension for healing [6 ▪ ,18].…”