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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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Monnet E, Hafez A. Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study. Vet Surg 2023; 52:716-720. [PMID: 36898966 DOI: 10.1111/vsu.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. STUDY DESIGN Experimental, ex-vivo, randomized study. ANIMALS A total of 24 male canine bladders with the urethra. METHODS Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. RESULTS The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012). CONCLUSION Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. CLINICAL SIGNIFICANCE A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.
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Affiliation(s)
- Eric Monnet
- Department of Clinical Science, Colorado State University, College of Veterinary Medicine and Biomedical Science, Fort Collins, CO, USA
| | - Ahmed Hafez
- Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
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Wang W, Yan S, Liu F, Chai W, Zuo J, Xiao J, Niels-Derrek S, Zhu Q, Sanghita B, Bogdan I, Wang K. A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: A multicenter, randomized controlled trial. J Orthop Surg (Hong Kong) 2021; 28:2309499020965681. [PMID: 33267734 DOI: 10.1177/2309499020965681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This randomized controlled study was designed to compare the wound closure efficacy and safety of barbed suture in comparison to the conventional interrupted suture for total knee arthroplasty (TKA). METHODS This multicenter, single-blind, randomized controlled trial enrolled 184 patients who underwent elective TKA between June 2017 and April 2018. The subjects were randomized between two groups. Surgical incision closure time was considered as the primary end point. RESULTS A total of 184 patients participated in this randomized controlled trial; 91 patients had wound closure that involved barbed suture and 93 patients underwent conventional treatment-that is interrupted suturing with nonbarbed sutures. The surgical incision closure time was shorter (p < 0.0001) in the barbed suture group compared with the control group (15.5 ± 4.88 vs. 20.9 ± 6.30 min). However, both groups were found to be equal in terms of the rate of postoperative complications. CONCLUSION Usage of the symmetric anchor designed barbed suture is safe, efficacious, and demonstrates a decrease in surgical incision closure time in patients undergoing TKA compared to interrupted closure using conventional sutures. Future studies are warranted to demonstrate clinical and economic benefits of barbed sutures.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Second Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Liu
- Department of Orthopedics, Jiangsu Province Hospital, Nanjing, China
| | - Wei Chai
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jun Xiao
- Department of Orthopedics, Tongji Hospital, Wuhan, China
| | | | - Qing Zhu
- Ethicon Inc., Somerville, NJ, USA
| | | | | | - Kunzheng Wang
- Department of Orthopedics, Second Hospital of Xi'an Jiaotong University, Xi'an, China
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Lin Y, Liao B, Lai S, Huang J, Du L, Wang K, Li H. The application of barbed suture during the partial nephrectomy may modify perioperative results: a systematic review and meta-analysis. BMC Urol 2019; 19:5. [PMID: 30630449 PMCID: PMC6329109 DOI: 10.1186/s12894-018-0435-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/26/2018] [Indexed: 02/05/2023] Open
Abstract
Background Barbed sutures can avoid knot tying and speed the suture placement in the PN(partial nephrectomy). On account of the impact on clinical outcomes are ambiguous, this study is determined to identify the application of barbed suture during PN. Methods ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed and EMBASE were searched for RCTs(randomized controlled trials) and cohort studies focusing on the comparison of barbed and traditional sutures in PN(last updated on Feb in 2015). According to Cochrane Library’s suggestion, quality assessment was performed. Review Manager was applied to analyze all the data and sensitivity analyses were performed through omitting each study sequentially. Results Eight cohort studies and none of RCTs proved eligible (risk of bias: moderate to low,431 patients). Warm ischemia time(MD = − 6.55,95% CI -8.86 to − 4.24, P < 0.05) decreased statistically in the barbed suture group, as well as operative time(MD = − 11.29,95% CI -17.87 to-4.71, P < 0.05). Postoperative complications also reduced significantly(OR = 0.44, 95% CI 0.24 to0.80, P < 0.05). Unidirectional barbed suture resulted in fewer postoperative complications based on the subgroup analysis(OR = 0.48,95% CI 0.24 to 0.94, P < 0.05). Conclusions The barbed suture may be a useful surgical innovation which can modify perioperative results for surgeons and patients. Randomly-designed studies with longer follow up and larger sample sizes are in the need of to explore the applicability. Electronic supplementary material The online version of this article (10.1186/s12894-018-0435-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yifei Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Banghua Liao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Sike Lai
- West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Jin Huang
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Liang Du
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Ye J, Lu J, Wang G, Ma L. Comparison between a novel knotless technique and the conventional single knot technique of laparoscopic radical prostatectomy by novice laparoscopists. J Int Med Res 2018; 46:4472-4479. [PMID: 30209964 PMCID: PMC6259390 DOI: 10.1177/0300060518773017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to investigate a novel knotless technique for novice laparoscopists in traditional laparoscopic radical prostatectomy. METHODS We studied 68 patients who had a novel technique performed in laparoscopic radical prostatectomy (knotless group) and 89 who had the conventional single knot technique (single knot group). The operations were all performed by novice laparoscopists with experience of fewer than 100 cases of laparoscopic radical prostatectomy. Knotless suture of the dorsal vein complex was conducted using a barbed self-retaining suture with three bites at the same location. The knotless urethrovesical anastomosis technique was conducted using a unidirectional single running fashion with a barbed self-retaining suture. RESULTS There were no significant differences in the estimated blood loss, complication rate, postoperative hospital stay, anastomotic leakage rate, continence at 6 months after surgery, and positive margin rate between the two groups. The mean anastomotic time (24.9 vs. 44.2 min), operative time (168.1 vs. 201.8 min), and duration of catheter placement (12.8 vs. 19.8 days) were shorter in the knotless group than in the single-knot group. CONCLUSIONS The knotless technique of laparoscopic radical prostatectomy is a safe and effective procedure.
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Affiliation(s)
- Jianfei Ye
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 5:980-991. [PMID: 29907547 DOI: 10.1016/j.euf.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Vesicourethral anastomosis (VUA) is a crucial step during radical prostatectomy (RP). Generally, either a continuous (CS) or an interrupted suture (IS) is used. However, there is no clear evidence if one technique is superior to the other. OBJECTIVE This study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP. EVIDENCE ACQUISITION The study was conducting according to the PRISMA guidelines. A systematic data base search (Pubmed, Embase, and Central) was performed. Outcomes included catheterization time, extravasation, anastomotic time, length of hospital stay, continence, and development of strictures. EVIDENCE SYNTHESIS A total of 2021 studies were retrieved, of which nine studies (1475 patients) were included in analysis. Results showed a shorter catheterization time (2.06 d; 95% confidence interval [CI]: 0.56-3.57; p=0.007), anastomotic time (6.39min; 95% CI: 3.68-9.10; p<0.001), and a lower rate of extravasation (odds ratio [OR]: 2.36; 95% CI: 1.26-4.43; p<0.007) in favor of CS. There were no differences between groups concerning length of hospital stay (0.40 d; 95% CI: -1.41-2.20; p=0.670) or continence at 3 mo (OR: 1.09; 95% CI: 0.83-1.44; p=0.540), 6 mo (OR: 1.04; 95% CI: 0.67-1.61; p=0.870) or 12 mo (OR: 1.43; 95% CI: 0.92-2.24; p=0.110), respectively. The incidence of urethral strictures was not different between the techniques (OR: 1.00; 95% CI: 0.42-2.40; p=1.000). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation tool was rated as low. CONCLUSIONS This meta-analysis showed advantages of CS for catheterization time, anastomotic time, and rate of extravasation without compromising other parameters. Although CS seems to offer favorable results, its technical challenge in open RP and the generally low quality of data makes a clear recommendation impossible. PATIENT SUMMARY Continuous and interrupted suturing are safe suture techniques for the vesicourethral anastomosis during radical prostatectomy. The choice of the suture technique should be based on surgeon's experience and technical approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017076126.
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7
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Yalcin S, Kibar Y, Tokas T, Gezginci E, Günal A, Ölcücü MT, Özgök IY, Gözen AS. In Vivo Comparison of "V-Loc 90 Wound Closure Device" With "Vicryl" and "Monocryl" in Regard to Tissue Reaction in a Rabbit Bladder Model. Urology 2018; 116:231.e1-231.e5. [PMID: 29505856 DOI: 10.1016/j.urology.2018.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.
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Affiliation(s)
- Serdar Yalcin
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Yusuf Kibar
- Koru Hospital, Department of Urology, Ankara, Turkey
| | - Theodoros Tokas
- General Hospital Hall i.T., Department of Urology and Andrology, Hall in Tirol, Austria
| | - Elif Gezginci
- Gulhane Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Armagan Günal
- Gulhane Training and Research Hospital, Department of Pathology, Ankara, Turkey
| | | | | | - Ali Serdar Gözen
- University of Heidelberg, SLK-Kliniken, Department of Urology, Heilbronn, Germany.
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Burttet LM, Varaschin GA, Berger AK, Cavazzola LT, Berger M, Silva B. Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital. Int Braz J Urol 2018; 43:1176-1184. [PMID: 28727367 PMCID: PMC5734083 DOI: 10.1590/s1677-5538.ibju.2016.0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/16/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature. Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature. Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status. Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.
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Affiliation(s)
| | | | - Andre Kives Berger
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Leandro Totti Cavazzola
- Universidade Federal do Rio Grande do Sul, RS, Brasil.,Departamento de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, RS, Brasil
| | - Milton Berger
- Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Brasil Silva
- Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, RS, Brasil
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Abstract
PURPOSE OF REVIEW Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. RECENT FINDINGS With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy. The evidence-based techniques of optimizing oncological outcomes including the lymph node dissection and improving cancer control through minimizing positive surgical margins are reviewed. Improvements in functional recovery has also been seen with technical modifications such as nerve sparing, preservation of the urethral support structures and the bladder neck and the urethra-vesical reconstruction. SUMMARY Robotic prostatectomy has demonstrated adequate long-term oncologic success and satisfactory functional recovery. As technology and techniques in robotic-assisted surgery evolve, surgeons will continue to optimize techniques to maximize functional outcome recovery and cancer control. Further studies are actively being conducted to provide level one evidence in multiple aspects of the robotic-assisted radical prostatectomy.
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Umranikar SA, Ubee SS, Selvan M, Cooke P. Barbed suture tissue closure device in urological surgery – a comprehensive review. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817702315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development and implementation of barbed sutures has transformed the technique of tissue closure with increasing application across multiple surgical disciplines. Changes in design and handling such as the introduction of absorbable and non-absorbable bidirectional barbed sutures reflect an increasing applicability in tissues of varying qualities. We undertook a comprehensive review of available literature to provide an evidence-based rationale for the clinical use of barbed suture tissue closure devices. We summarise uses along with advantages and disadvantages reported across a number of surgical specialties such as urology, orthopaedics, gynaecology and plastic surgery. Tangible benefits noted were faster closure speed, maintenance of suture integrity, improved efficiency in closure, avoidance of knots and possibly a cost-benefit effect. In terms of complications, the barbed sutures compared equally with standard sutures with no significant differences. In conclusion, barbed sutures have demonstrated versatility and safety across surgical specialties and compares favourably with standard sutures. There appears to be an increasing popularity in the use of barbed sutures with clear advantages to both surgeon and patient.
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Affiliation(s)
- Salil A Umranikar
- Department of Urology, University Hospital of North Midlands NHS Trust, UK
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Sarvpreet S Ubee
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Masilamani Selvan
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
| | - Peter Cooke
- Department of Urology, The Royal Wolverhampton Hospital NHS Trust, UK
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Dhom J, Bloes DA, Peschel A, Hofmann UK. Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures. J Orthop Res 2017; 35:925-933. [PMID: 27208547 DOI: 10.1002/jor.23305] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/11/2016] [Indexed: 02/04/2023]
Abstract
Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p < 0.001), but 1.4 times larger than on Ethilon II (p < 0.001) regarding S. aureus. Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925-933, 2017.
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Affiliation(s)
- Jonas Dhom
- Medical Faculty of the University of Tübingen, D-72076 Tübingen, Germany
| | - Dominik A Bloes
- Cellular and Molecular Microbiology Division, Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, D-72076 Tübingen, Germany
- German Center for Infection Research, Partner site Tübingen, D-72076 Tübingen, Germany
| | - Andreas Peschel
- Cellular and Molecular Microbiology Division, Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, D-72076 Tübingen, Germany
- German Center for Infection Research, Partner site Tübingen, D-72076 Tübingen, Germany
| | - Ulf K Hofmann
- Department of Orthopaedic Surgery, University Hospital of Tübingen, D-72076 Tübingen, Germany
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Moro FD, Beltrami P, Zattoni F. Can anastomotic urinary leakage in robotic prostatectomy be considered as a marker of surgical skill? Cent European J Urol 2017; 71:21-25. [PMID: 29732202 PMCID: PMC5926642 DOI: 10.5173/ceju.2018.1587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/10/2018] [Accepted: 02/10/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction The study was conducted to analyze whether the anastomotic urinary leakage (AUL) rate in robot-assisted radical prostatectomy (RARP) can be considered as a marker of surgical skill. Material and methods Post-operative cystograms taken after RARP, performed between 2006 and 2016 at a third-level university urology center, were prospectively collected. Cystograms were scheduled for all patients on post-operative day 6, but were performed over a range from days 4 to 10 (median 6). In cases of mild, moderate or excessive AUL (according to Han's classification), catheters were maintained; in the other cases, they were removed. Results Data from 1366 consecutive patients undergoing RARP were collected. The incidence of AUL at first check-up was 18.1%, with a descending trend when RARP were performed by the same surgeon. Evaluating the influence of differing technical modifications on leakage, the AUL rate was significantly lower after the introduction of posterior reconfigurations and a single posterior stitch. The introduction of barbed sutures was initially associated with an increase of leakage, but only in the first year. Conclusions This study describes the effect of increasing experience and technical modifications in RARP on the AUL rate in a third-level university Italian center over a 10-year period; by stratifying data, we demonstrated a strong correlation between robotic surgical skill and AUL rate, which can therefore be used as an indicator of surgical proficiency.
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Affiliation(s)
- Fabrizio Dal Moro
- University of Padova, Department of Surgery, Oncology and Gastroenterology - Urology, Padova, Italy
| | - Paolo Beltrami
- University of Padova, Department of Surgery, Oncology and Gastroenterology - Urology, Padova, Italy
| | - Filiberto Zattoni
- University of Padova, Department of Surgery, Oncology and Gastroenterology - Urology, Padova, Italy
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Han JL, Gandhi S, Bockoven CG, Narayan VM, Dahm P. The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality. BJU Int 2016; 119:638-649. [DOI: 10.1111/bju.13653] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Julia L. Han
- Department of Urology; University of Florida; Gainesville FL USA
| | | | | | - Vikram M. Narayan
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
| | - Philipp Dahm
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
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Contemporary refinements in laparoscopic radical prostatectomy. Actas Urol Esp 2016; 40:475-6. [PMID: 27207598 DOI: 10.1016/j.acuro.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
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Chawla H, van der List JP, Fein NB, Henry MW, Pearle AD. Barbed Suture Is Associated With Increased Risk of Wound Infection After Unicompartmental Knee Arthroplasty. J Arthroplasty 2016; 31:1561-7. [PMID: 26872587 DOI: 10.1016/j.arth.2016.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Literature addressing the risks of barbed suture in arthroplasty remains limited. No study to our knowledge has compared rates of wound infection between barbed and conventional suture after unicompartmental knee arthroplasty (UKA). We hypothesized that barbed suture would be associated with an increased risk of wound infection in patients undergoing UKA. METHODS Electronic records were retrieved for 1040 UKA procedures. Odds ratios with postoperative wound infection as the outcome and barbed suture as the exposure were calculated. Binary logistic regression corrected for age, gender, body mass index, operative time, and risk factors (smoking, diabetes, renal insufficiency, and immunosuppression). Barbed suture consisted of Quill #2 polydioxanone (or #0 Vicryl) for deep closure and Quill 2-0 Monoderm for subcuticular closure. Conventional suture consisted of #0 Vicryl for deep closure and subcuticular 2-0 Monocryl or staples for skin closure. RESULTS A total of 839 procedures were included. Barbed suture was used in 333 surgeries, and conventional suture was used in 506. Eight cases of postoperative wound infection were identified. All infections occurred in the barbed suture cohort. Regression analysis revealed an association between subcuticular barbed suture and postoperative wound infection (odds ratio = 22.818, confidence interval = 2.69-2923.91; P = .0074). CONCLUSIONS The findings indicate that the use of barbed suture in subcuticular layer closure is associated with an increased risk of wound infection. This may be exacerbated by early intensive mobilization, commonly undertaken after UKA to permit rapid functional return. We recommend against the use of barbed suture for subcuticular layer closure in UKA.
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Affiliation(s)
- Harshvardhan Chawla
- Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Jelle P van der List
- Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Nicole B Fein
- Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Michael W Henry
- Division of Infectious Disease, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Andrew D Pearle
- Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
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The Single-Knot Running Vesicourethral Anastomosis after Minimally Invasive Prostatectomy: Review of the Technique and Its Modifications, Tips, and Pitfalls. Prostate Cancer 2016; 2016:1481727. [PMID: 27340567 PMCID: PMC4906212 DOI: 10.1155/2016/1481727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/12/2016] [Indexed: 12/27/2022] Open
Abstract
The vesicourethral anastomosis represents a step of major difficulty at the end of minimally invasive radical prostatectomy. Over 10 years ago, we have devised the single-knot running vesicourethral anastomosis, which has been widely adopted in urologic departments worldwide. Aim of the current paper is to review the technique, its adaptability in complex situations, its complications, and possible modifications, including the use of barbed sutures.
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Mallikarjuna C, Nayak P, Reddy KPC, Ghouse SM, Ragoori D, Bendigeri MT, Reddy S. The AINU Technique for Laparoscopic Vesico-Vaginal Fistula Repair: A Preliminary Report. Urol Int 2015; 95:357-60. [PMID: 26413889 DOI: 10.1159/000439355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION With safe obstetric practices now globally available, most vesico-vaginal fistulas (VVF) presenting in recent times are secondary to various gynecologic surgeries. Most of them are supra-trigonal in location. Laparoscopic repair of VVF is gaining ground as an alternative to open repair of VVF. In this study, we describe our initial experience with a novel technique of laparoscopic VVF repair involving a limited transverse cystotomy for access and a single-layered barbed suture closure of bladder. MATERIALS AND METHODS Twenty cases of supra-trigonal VVFs following gynecologic surgeries were taken up for repair by our novel technique. The mean age of the patients was 32 years and the mean VVF size was 1.5 cm. RESULTS The mean operative time was 54 min. Estimated mean blood loss was 30 ml and the mean postoperative stay was 2.5 days. None of the patients had any recurrence with a mean follow-up of 14 months. CONCLUSION The limited transverse cystotomy approach has advantages in decreasing the operative time, improving ease of laparoscopic suturing, allowing an automatic separation of suture lines and allowing for an easier anterior dissection of the bladder to reduce tension on the suture line if necessary. Further this approach provides excellent results in select patients of supra-trigonal VVF in terms of continence and postoperative bladder overactivity.
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