Abstract
Purpose
To evaluate the usage of unidirectional barbed suture and its related implications in various surgeon-controlled robotic reconstructive urologic surgeries.
Methods
From March 2010 to March 2011, all patients undergoing various surgeon-controlled robotic reconstructive urologic surgeries utilizing barbed sutures were prospectively enrolled in this study. Type and number of procedure performed were noted. Intraoperative and peri-operative outcomes potentially related to suture technique and material were recorded.
Results
This study reports on 210 patients, in whom barbed suture was used during this period. These included partial nephrectomy (20), pyeloplasty (9), ureteric tailoring and reimplantation (1), closure of bladder after Nephroureterectomy with excision of bladder cuff (8), closure of vaginal cuff in female radical cystectomy (12), partial cystectomy (1), radical prostatectomy (152), simple prostatectomy (2), vesicovaginal fistula repair (3), sacrocolpopexy (1), and hernia repair (1). We encountered 5 instances (2.38%) of tissue cut through possibly attributable to the use of barbed suture and 4 instances of misplacement of suture occurred, of these two required a new suture, whereas retrograde pull back of suture and needle was performed in 2 cases. No instance of slip back/loosening of suture was noted once it was tightened. At mean follow-up of 6.8 (1–14 months) months, we did not encounter any complications of urinary leakage, stone formation or fistula or any clinical evidence of urinary tract obstruction due to the use of barbed suture.
Conclusion
Use of unidirectional barbed suture is safe, feasible, and efficient at short-term follow-up for reconstructive part of urological procedures.
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References
Greenberg JA (2010) The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol 3(3):82–91
Rosen AD (2010) Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg 125(3):1024–1027
Weld KJ, Ames CD, Hruby G, Humphrey PA, Landman J (2006) Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction. Urology 67(6):1133–1137
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
Shikanov S, Wille M, Large M et al (2009) Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy. J Endourol 23(7):1157–1160
Sammon J, Petros F, Sukumar S et al (2011) Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol 25(3):529–533
Kaul S, Sammon J, Bhandari A, Peabody J, Rogers CG, Menon M (2010) A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients. J Endourol 24(11):1789–1793
Tewari AK, Srivastava A, Sooriakumaran P et al (2010) Use of a novel absorbable barbed plastic surgical suture enables a “self-cinching” technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol 24(10):1645–1650
Williams SB, Alemozaffar M, Lei Y 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
Hemal AK, Agarwal MM, Babbar P (2011) Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol. doi:10.1007/s11255-011-9967-0
Hruby G, Weld KJ, Marruffo F et al (2007) Comparison of novel tissue apposing device and standard anastomotic technique for vesicourethral anastomoses. Urology 70(1):190–195
Einarsson JI, Vellinga TT, Twijnstra AR, Chavan NR, Suzuki Y, Greenberg JA (2010) Bidirectional barbed suture: an evaluation of safety and clinical outcomes. JSLS 14(3):381–385
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
Shermak MA, Mallalieu J, Chang D (2010) Barbed suture impact on wound closure in body contouring surgery. Plast Reconstr Surg 126(5):1735–1741
Jandali S, Nelson JA, Bergey MR, Sonnad SS, Serletti JM (2011) Evaluating the use of a barbed suture for skin closure during autologous breast reconstruction. J Reconstr Microsurg 27(5):277–286
Workman M, Deschamps-Braly J, Morgan A, Sawan K (2010) Bidirectional barbed suture migration: a unique complication after intracuticular closure. Aesthet Plast Surg 35(4):672–673
Thubert T, Pourcher G, Deffieux X (2011) Small bowel volvulus following peritoneal closure using absorbable knotless device during laparoscopic sacral colpopexy. Int Urogynecol J Pelvic Floor Dysfunct 22(6):761–763
Demyttenaere SV, Nau P, Henn M et al (2009) Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov 16(3):237–242
Ingle NP, King MW (2010) Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues. J Biomech 43(2):302–309
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Shah, H.N., Nayyar, R., Rajamahanty, S. et al. Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience. Int Urol Nephrol 44, 775–785 (2012). https://doi.org/10.1007/s11255-011-0075-y
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DOI: https://doi.org/10.1007/s11255-011-0075-y