Published in:
01-09-2015 | Review
Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis
Published in: Archives of Gynecology and Obstetrics | Issue 3/2015
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Purpose
Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological
procedures nowadays. Minimally invasive procedures seem to increase the risk of vaginal cuff dehiscence (VCD). Barbed suture is a new class of suture introduced to aid surgeons during laparoscopic suturing, with the aim to reduce operative time, blood loss, and vaginal dehiscence.
Methods
We identified all articles that report a series of laparoscopic or robotic-assisted hysterectomy using barbed suture compared to conventional suture for vaginal cuff closure. The main outcome measures were vaginal cuff suturing time, vaginal bleeding, and vaginal dehiscence with or without small bowel evisceration. Suturing time was meta-analyzed as the standardized mean difference, which is the difference in means of two arms divided by pooled standard deviation with 95 % confidence intervals. For vaginal bleeding and dehiscence risk difference were calculated for each study and then meta-analyzed. Fixed models were considered if heterogeneity was low (I
2 < 50 %), otherwise random models were preferred.
Results
We show that minor bleeding (RD = 0, 95 % CI 0.03–0.03; p value = 0.907) and
VCD (RD = −0.01, 95 % CI 0.02–0.00; p value = 0.119) are comparable in minimally invasive hysterectomy with or without the use of barbed suture. The major bleeding (RD = −0.03; 95 % CI 0.05–0.00; p value = 0.047) appears borderline significant, but the difference between the two types of sutures is not high and the upper limit of 95 % IC is equal to 0 so they were considered comparable. Instead, meta-analysis on vaginal cuff suturing time demonstrates that suturing time is reduced with the use of barbed suture (SMD = −0.96, 95 % CI 1.26–0.70; p value <0.001).
Conclusions
Barbed suture is safe and well tolerated as traditional sutures and is associated with reduced operative time of laparoscopic vaginal vault closure.