Top

Published in:

01-05-2015 | Original Article

A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy

Authors: Jasmine Tan-Kim, Charles W. Nager, Cara L. Grimes, Karl M. Luber, Emily S. Lukacz, Heidi W. Brown, Kimberly L. Ferrante, Keisha Y. Dyer, Anna C. Kirby, Shawn A. Menefee

Published in: International Urogynecology Journal | Issue 5/2015

Abstract

Introduction and hypothesis

We investigated the efficiency and efficacy of vaginal mesh attachment using interrupted, non-barbed, delayed absorbable sutures in comparison with a running, barbed, delayed absorbable suture during laparoscopic sacrocolpopexy (LSC) and robotic sacrocolpopexy (RSC).

Methods

Women undergoing LSC or RSC were recruited. Participants were randomized to at least six 0 PDS non-barbed interrupted sutures or at least six passes of a 1 PDS barbed suture (Quill™) on each anterior and posterior polypropylene mesh leaflet. The primary outcome was the time to attach the mesh to the vagina. The LSC and RSC groups were block randomized by suture type. Secondary outcomes included: (1) intraoperative surgeon assessment of satisfaction as measured using a 10-cm visual analog scale (VAS), (2) postoperative POP-Q evaluation for anatomic failure, and (3) overall appearance of vaginal walls measured using a VAS.

Results

Of the 64 included subjects who were randomized, 32 had mesh attachment with the barbed suture (16 LSC, 16 RSC) and 32 had attachment with non-barbed sutures (16 LSC, 16 RSC). Among all the subjects (LSC and RSC), the non-barbed suture group had significantly longer mesh attachment times than the barbed suture group (42 vs. 29 min, p < 0.001). The non-barbed suture group had significantly better scores for intraoperative ease of suture placement, surgeon satisfaction with mesh appearance, and global satisfaction. At 12 months, there were no significant differences in anatomic failure between the suture groups or overall appearance of the vaginal walls (p > 0.05).

Conclusions

The barbed suture technique was 11 – 16 min faster for attaching mesh to the vagina than the non-barbed suture technique. Anatomic outcomes at 12 months were comparable between the suture groups. It is reasonable to use a running, barbed suture in minimally invasive sacrocolpopexy.

Available only for authorised users

Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X et al (2009) The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 55(5):1089–1103CrossRefPubMed

Kramer BA, Whelan CM, Powell TM, Schwartz BF (2009) Robot-assisted laparoscopic sacrocolpopexy as management for pelvic organ prolapse. J Endourol 23(4):655–658CrossRefPubMed

Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112(6):1201–1206CrossRefPubMed

Paraiso MFR, Walters MD, Rackley RR, Melek S, Hugney C (2005) Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol 192(5):1752–1758CrossRefPubMed

Ross JW, Preston M (2005) Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol 12(3):221–226CrossRefPubMed

Milone M, Di Minno MND, Galloro G, Maietta P, Bianco P, Milone F et al (2013) Safety and efficacy of barbed suture for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass. J Laparoendosc Adv Surg Tech A 23(9):756–759CrossRefPubMed

Alessandri F, Remorgida V, Venturini PL, Ferrero S (2010) Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J Minim Invasive Gynecol 17(6):725–729CrossRefPubMed

Greenberg JA, Einarsson JI (2008) The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol 15(5):621–623CrossRefPubMed

Einarsson JI, Grazul-Bilska AT, Vonnahme KA (2011) Barbed vs standard suture: randomized single-blinded comparison of adhesion formation and ease of use in an animal model. J Minim Invasive Gynecol 18(6):716–719CrossRefPubMed

10.

Zorn KC, Trinh Q-D, Jeldres C, Schmitges J, Widmer H, Lattouf J-B et al (2012) Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int 109(10):1526–1532CrossRefPubMed

11.

Sammon J, Kim T-K, Trinh Q-D, Bhandari A, Kaul S, Sukumar S et al (2011) Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology 78(3):572–579CrossRefPubMed

12.

Greenberg JA, Clark RM (2009) Advances in suture material for obstetric and gynecologic surgery. Rev Obstet Gynaecol 2(3):146–158

13.

Moran ME, Marsh C, Perrotti M (2007) Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol 21(10):1175–1178CrossRefPubMed

14.

Shepherd JP, Higdon HL, Stanford EJ, Mattox TF (2010) Effect of suture selection on the rate of suture or mesh erosion and surgery failure in abdominal sacrocolpopexy. Female Pelvic Med Reconstr Surg 16(4):229–233CrossRefPubMed

15.

Tan-Kim J, Menefee SA, Lippmann Q, Lukacz ES, Luber KM, Nager CW (2014) A pilot study comparing anatomic failure after sacrocolpopexy with absorbable or permanent sutures for vaginal mesh attachment. Perm J 18(4):40–44.PubMedCentralPubMed

16.

Rashid RM, Rashid R, Sartori M, White LE, Villa MT, Yoo SS et al (2007) Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers. Arch Dermatol 143(7):869–872PubMed

17.

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17CrossRefPubMed

18.

Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC et al (2014) Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 311(10):1023–1034CrossRefPubMedCentralPubMed

19.

Grimes CL, Tan-Kim J, Garfin SR, Nager CW (2012) Sacral colpopexy followed by refractory Candida albicans osteomyelitis and discitis requiring extensive spinal surgery. Obstet Gynecol 120(2 Pt 2):464–468CrossRefPubMed

20.

Hewer CL (1956) The physiology and complications of the Trendelenburg position. Can Med Assoc J 74(4):285–288PubMedCentralPubMed

21.

Gollapalli L, Papapetrou P, Gupta D, Fuleihan SF (2013) Post-operative alopecia after robotic surgery in steep Trendelenburg position: a restated observation of pressure alopecia. Middle East J Anesthesiol 22(3):343–345PubMed

22.

Ritter EM, McClusky DA, Gallagher AG, Smith CD (2005) Real-time objective assessment of knot quality with a portable tensiometer is superior to execution time for assessment of laparoscopic knot-tying performance. Surg Innov 12(3):233–237CrossRefPubMed

23.

Patsner B (2000) Mesh erosion into the bladder after abdominal sacral colpopexy. Obstet Gynecol 95(6 Pt 2):1029CrossRefPubMed

24.

Demyttenaere SV, Nau P, Henn M, Beck C, Zaruby J, Primavera M et al (2009) Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov 16(3):237–242CrossRefPubMed

25.

Einarsson JI, Cohen SL, Gobern JM, Sandberg EM, Hill-Lydecker CI, Wang K et al (2013) Barbed versus standard suture: a randomized trial for laparoscopic vaginal cuff closure. J Minim Invasive Gynecol 20(4):492–498CrossRefPubMed

26.

Jeung IC, Baek JM, Park EK, Lee HN, Kim CJ, Park TC et al (2010) A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy. Arch Gynecol Obstet 282(6):631–638CrossRefPubMed

27.

Siedhoff MT, Yunker AC, Steege JF (2011) Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture. J Minim Invasive Gynecol 18(2):218–223CrossRefPubMed

28.

Borahay MA, Oge T, Walsh TM, Patel PR, Rodriguez AM, Kilic GS (2014) Outcomes of robotic sacrocolpopexy using barbed delayed absorbable sutures. J Minim Invasive Gynecol 21(3):412–416CrossRefPubMed

29.

Villa MT, White LE, Alam M, Yoo SS, Walton RL (2008) Barbed sutures: a review of the literature. Plast Reconstr Surg 121(3):102e–108eCrossRefPubMed

30.

Williams SB, Alemozaffar M, Lei Y, Hevelone N, Lipsitz SR, Plaster BA et al (2010) Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes. Eur Urol 58(6):875–881CrossRefPubMed

Title: A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy
Authors: Jasmine Tan-Kim
Charles W. Nager
Cara L. Grimes
Karl M. Luber
Emily S. Lukacz
Heidi W. Brown
Kimberly L. Ferrante
Keisha Y. Dyer
Anna C. Kirby
Shawn A. Menefee
Publication date: 01-05-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 5/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-014-2566-8

At a glance: The STEP trials

Springer Medicine

A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2015

Conservative management of vesico-vaginal fistula after uterine and partial bladder necrosis due to embolization as a treatment for postpartum hemorrhage

Effects of posture and squatting on the dynamics of micturition

Döderlein–Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy

Vaginal native tissue repair versus transvaginal mesh repair for apical prolapse: how utilizing different methods of analysis affects the estimated trade-off between reoperation for mesh exposure/erosion and reoperation for recurrent prolapse

Urogynecology digest

Bladder pseudodiverticulum and debilitating dyspareunia: diagnostic and management dilemmas of a rare case