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Special Barbed Suture Cuts Operative Time


 

From the Annual Meeting of the AAGL

Major Finding: Duration of surgery was significantly shorter with the barbed suture, 117.6 vs. 161.2 minutes for the smooth suture. The length of hospital stay was also significantly reduced, 0.58 vs. 0.97 days.

Data Source: Retrospective analysis of 138 consecutive laparoscopic myomectomy cases.

Disclosures: Dr. Cohen said that the study's principal investigator, Dr. Jon I. Einarsson, is a consultant for Ethicon-Endo Surgery. The authors said they have no financial relationship with the device manufacturer, Angiotech Pharmaceuticals.

LAS VEGAS – Use of bidirectional barbed suture reduced operative time by approximately 40 minutes and decreased the length of hospital stay by half a day in a retrospective comparison to use of conventional smooth suture for closure in laparoscopic myomectomy.

Bidirectional barbed suture, in which barbs are cut into the suture so that they are facing in a direction opposite to that of the needle, are designed to resist migration.

The Quill bidirectional barbed suture (Angiotech Pharmaceuticals) has been commercially available in the United States since 2007.

Anecdotally, use of the barbed suture eliminates backsliding of the suture, thereby facilitating myometrial closure, said Dr. Sarah Cohen of Brigham and Women's Hospital, Boston. Dr. Cohen presented the results of the study, which were subsequently published (J. Minim. Invasive Gynecol. 2011;18:92-5).

Perioperative outcomes for a total of 138 consecutive cases of laparoscopic myomectomy performed by a single surgeon were reviewed, including 31 with conventional smooth suture during February 2007 through March 2008 and 107 cases performed from March 2008 through April 2010 using bidirectional barbed suture.

Aside from the suture choice, operative technique was similar for all cases, Dr. Cohen said at the meeting.

There were no significant differences between the two patient groups in demographic characteristics.

The most common indications for undergoing laparoscopic myomectomy were pelvic pain and/or pressure (in 30 smooth and 81 barbed suture patients) and abnormal uterine bleeding (in 11 and 41). The remainder of patients underwent the procedure for other reasons.

The duration of surgery was significantly shorter with the barbed suture, 117.6 minutes compared with 161.2 minutes for the smooth suture.

The length of hospital stay was also significantly reduced, 0.58 vs. 0.97 days. The estimated blood loss, number of myomas removed, and weight of myomas did not differ between the two groups, she reported.

In order to account for any impact of a surgical learning curve, the 31 cases using smooth suture were compared with just the first 31 cases performed after the switch to bidirectional barbed suture. The duration of surgery and the hospital stay were both still significantly shorter with the barbed suture (121.9 minutes and 0.42 days).

There was one intraoperative complication in a patient with the smooth suture, which was unrelated to the suturing. There were no intraoperative complications with the barbed suture.

Postoperative complications among the barbed suture patients included two incision site infections (1.9%), four urinary tract infections (3.7%), one ileus (0.9%), and one blood transfusion (0.9%). In the smooth suture group, there were two UTIs (6.4%). The differences in complication rates were not significant, she noted.

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