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WJOLS
10.5005/jp-journals-10033-1206
Barbed Sutures in Laparoscopic Myomectomy—Realistic Expectations: A Critical Review
REVIEW ARTICLE
Barbed Sutures in Laparoscopic Myomectomy—Realistic
Expectations: A Critical Review

Shyjus Puliyathinkal

2
ABSTRACT the intramural myoma too by the laparoscopic route. Today,
The purpose of this review is to critically analyze the laparoscopic myomectomy is on its way to attaining the
effectiveness of self-retaining barbed sutures in intracorporeal status of a superior approach for women because of the
suturing in terms of tissue approximation, intraoperative blood proven advantages with respect to postoperative pain, shorter
loss, reduction in operative time, duration of hospital stay and
postoperative adhesions. hospitalization and convalescence, and for the obvious
cosmetic reasons, in comparison to the open approach.
Materials and methods: We analyzed 9 published articles to
critically look at the effectiveness of self-retaining barbed suture However, laparoscopic myomectomy has always been
in laparoscopic myomectomy. A literature research was subjected to considerable debate. In particular, for intramural
performed using internet. myoma, the technique is reputed to be technically difficult,
Discussion: Barbed suture seems to be a reasonably good of longer duration, with more blood loss. The quality of the
option for intracorporeal suturing in laparoscopic myomectomy.
uterine scar obtained by this technique is also questionable,
The time required for intracorporeal suturing was significantly 3
to withstand a subsequent pregnancy.
less with barbed suturing (11.5 min/9.9 min/126s) when compared
to the conventional suturing (17.4 min/15.8 min/272.6s). The total The purpose of this review is to critically analyze the
operative time required with barbed sutures (118 min/51 min) effectiveness of self-retaining barbed sutures in
was found to be significantly reduced in comparison with intracorporeal suturing in terms of tissue approximation,
conventional sutures (162 min/ 58 min). The intraoperative blood
loss was found to be significantly reduced in 2 of the 3 studies intraoperative blood loss, reduction in operative time,
with the use of barbed sutures. Fall in hemoglobin and duration duration of hospital stay and postoperative adhesions.
of hospital stay also seems to be reduced with the self-retaining Bidirectional barbed suture is a new design that incorporates
sutures.
tiny barbs spaced evenly along the length of the suture cut
Conclusion: The self-retaining barbed suture seems to be an facing in opposite directions from the midpoint. Unlike
5,7
effective option for intracorporeal suturing in laparoscopic
myomectomy with numerous benefits. the smooth-textured traditional suture, the bidirectional
barbs on this new product introduce a new paradigm in
Keywords: Laparoscopic myomectomy, Barbed sutures in
which wound tension is evenly distributed across the length
laparoscopic myomectomy, Self-retaining sutures in
laparoscopic myomectomy, Scar integrity with barbed sutures, of the suture line rather than at the knotted end. 8,10 No knots
Complications of laparoscopic myomectomy. are required with bidirectional barbed suture. 9
How to cite this article: Puliyathinkal S. Barbed Sutures in
Laparoscopic Myomectomy—Realistic Expectations: A Critical MATERIALS AND METHODS
Review. World J Lap Surg 2013;6(3):167-169.
A literature search was performed using Google, Yahoo,
Source of support: Nil
Springerlink and Highwire Press. The following search
Conflict of interest: None declared terms were used: laparoscopic myomectomy, barbed sutures
in laparoscopic myomectomy, self-retaining sutures in
INTRODUCTION
laparoscopic myomectomy, scar integrity with barbed
Fibroid uterus is one of the commonest pathology affecting sutures, complications of laparoscopic myomectomy.
up to 30% of women in reproductive age group. It can Considering the fact that this suture is a relatively newer
present with a wide spectrum of symptoms including pelvic entry in this field, 9 of the available published articles were
pain, abnormal uterine bleeding, pressure symptoms, pelvic chosen for this review.
mass and infertility. The current scenario of delayed The criteria of selection were:
marriages and delayed conception after marriage can • Type of operative procedure: Laparoscopic myomectomy
aggravate the impact of such hormone responsive uterine with intracorporeal suturing with barbed sutures or
pathologies. Despite this trend, there is an increasing desire conventional suturing with knotting.
for fertility preservation, thus creating a renewed interest in • The institution where the procedure was practiced
conservative uterine surgeries in comparison to hysterectomies. (preference for those specialized for laparoscopic surgery).
Laparoscopic myomectomy, in its early years (1970’s) Laparoscopic pelvic myomectomy procedures practiced:
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was meant exclusively for subserous myomas. From the • The uterus was always cannulated to allow the correct
beginning of the 1990s, techniques were developed to tackle exposure of myomas.
World Journal of Laparoscopic Surgery, September-December 2013;6(3):167-169 167