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

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.

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References

  1. 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):1089–1103

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. 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):1752–1758

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. 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):756–759

    Article  PubMed  Google Scholar 

  7. 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):725–729

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. 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):716–719

    Article  PubMed  Google Scholar 

  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):1526–1532

    Article  PubMed  Google Scholar 

  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):572–579

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  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):1175–1178

    Article  PubMed  Google Scholar 

  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):229–233

    Article  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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):869–872

    PubMed  Google Scholar 

  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):10–17

    Article  CAS  PubMed  Google Scholar 

  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):1023–1034

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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):464–468

    Article  PubMed  Google Scholar 

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

    PubMed Central  CAS  PubMed  Google Scholar 

  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):343–345

    PubMed  Google Scholar 

  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):233–237

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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):237–242

    Article  PubMed  Google Scholar 

  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):492–498

    Article  PubMed  Google Scholar 

  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):631–638

    Article  PubMed  Google Scholar 

  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):218–223

    Article  PubMed  Google Scholar 

  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):412–416

    Article  PubMed  Google Scholar 

  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–108e

    Article  PubMed  Google Scholar 

  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):875–881

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

None.

Funding

This study was partially funded by the Kaiser Permanente Southern California Regional Research Committee (cost center 01-211-7774). Retail gift cards to the value of US$25 were given to subjects recruited through Kaiser Permanente San Diego at their 6-month follow-up visit. Investigators were not funded through this grant and participated on a voluntary basis.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Jasmine Tan-Kim.

Additional information

Registration with ClinicalTrials.gov

1. “Affixing Polypropylene Mesh Using Barbed Suture (Quill™ SRS) During Robotic Assisted Laparoscopic Sacrocolpopexy (Quill RALSC)”. ClinicalTrials.gov Identifier: NCT01608568

2. “Affixing Polypropylene Mesh Using Barbed Suture (Quill™ Srs) During Laparoscopic Sacrocolpopexy Randomized Controlled Trial (Quill Lsc) (QUILL-LSC)”. ClinicalTrials.gov Identifier: NCT01551992

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Cite this article

Tan-Kim, J., Nager, C.W., Grimes, C.L. et al. A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy. Int Urogynecol J 26, 649–656 (2015). https://doi.org/10.1007/s00192-014-2566-8

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  • DOI: https://doi.org/10.1007/s00192-014-2566-8

Keywords

  • Barbed suture
  • Mesh attachment
  • Sacrocolpopexy