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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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Haas-Lützenberger EM, Strolla J, Giunta R, Volkmer E. [Current Trends in Flexor Tendon Surgery: Results of a National Online Survey]. HANDCHIR MIKROCHIR P 2023; 55:350-357. [PMID: 37500070 DOI: 10.1055/a-2060-0755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Within the last 50 years, there has been a change in trend in flexor tendon surgery. After the introduction of the 2-strand technique, the 4-strand technique was propagated in the 1990s. In order to obtain a status quo of which technique is used in Germany and if the gold standard of the 4-strand suture has changed in favour of a 6-strand suture, we conducted an online survey among members of the DGH ("Deutsche Gesellschaft für Handchirurgie", German Society for Hand Surgery) on the suture technique of flexor tendon injuries zone 2. MATERIAL AND METHODS An online survey was conducted and sent out by email to all DGH members. The questionnaire included 7 questions. Participants accessed the survey via a link. RESULTS 155 hand surgeons from Germany participated in the survey. All of them answered the questionnaire in full and all questionnaires were included in the evaluation. The main question of how many strands are currently used for core suturing was answered as follows: 21% (n=32) of the 155 participants (TN) stated that they use a 2-strand suture, 53% used (n=82) a 4-strand suture and 10% used a 6-strand suture. Regarding techniques, 81 TN used the Kirchmayr-Kessler technique or a modification of it, 9 TN used the M-Tang technique, and 15 TN indicated "other technique". The question about the application of an epitendinous suture was overwhelmingly answered with "yes". Here, 98.2% agreed. Only with regard to the suture material, different opinions were found. 68% (n=106) use an absorbable monofilament suture (such as PDS). Just under a quarter (23%, n=36) use a non-absorbable monofilament suture (such as Prolene). CONCLUSION Flexor tendon surgery has changed considerably due to intensive advances in research during the last decades. It was interesting to note in our survey that German hand surgeons have adapted their suture technique within the last years based on the results of the literature. Our results clearly show that convincing scientific data has an influence on the choice of surgical technique and that discussions about new techniques, e. g. in the context of annual meetings, may well stimulate the auditorium to rethink.
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Affiliation(s)
| | - Johannes Strolla
- Abteilung für Plastische und Ästhetische Chirurgie, Handchirurgie, Klinik Dr. Guth, Hamburg, Germany
| | - Riccardo Giunta
- Abteilung für Hand-, Plastische & Ästhetische Chirurgie, Klinikum der Universität München, LMU München, München, Germany
| | - Elias Volkmer
- Klinik für Handchirurgie, Helios Klinikum München West, München, Germany
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Gulotta G, Iannella G, Meccariello G, Cammaroto G, Visconti IC, de Vincentiis M, Greco A, Pelucchi S, Magliulo G, Ruoppolo G, Maniaci A, Cocuzza S, La Mantia I, De Vito A, Abita P, Vicini C. Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean? Am J Otolaryngol 2021; 42:102994. [PMID: 33639448 DOI: 10.1016/j.amjoto.2021.102994] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP). MATERIALS AND METHODS 488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort. RESULTS E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166). CONCLUSIONS E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.
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Affiliation(s)
- Giampiero Gulotta
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy.
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy
| | - Irene Claudia Visconti
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy
| | - Marco de Vincentiis
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy.
| | - Antonio Greco
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy.
| | - Stefano Pelucchi
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy.
| | - Giuseppe Magliulo
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy
| | - Giovanni Ruoppolo
- Department of "Organi di Senso", Sapienza University of Rome, Viale del Policlinico, 151-00161 Rome, Italy.
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Ear, Nose, Throat Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Ear, Nose, Throat Section, University of Catania, Catania, Italy.
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Ear, Nose, Throat Section, University of Catania, Catania, Italy.
| | - Andrea De Vito
- Head&Neck Department, Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Romagna Health Company, 48121 Ravenna, Italy
| | - Pietro Abita
- Unit of Otorhinolaringology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy; Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy.
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Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis. Arch Plast Surg 2019; 46:228-234. [PMID: 30913576 PMCID: PMC6536874 DOI: 10.5999/aps.2018.00962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/16/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. METHODS The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. RESULTS The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). CONCLUSIONS This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.
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