Page 44 - Laparoscopic Surgery Online Journal

Shyjus Puliyathinkal

• To reduce vascularization and blood loss, the myomas TOTAL DURATION OF SURGERY (TABLE 2)
were injected with diluted vasopressin.
In the study done by Franco Alessandri et al 2010 it was
• For subserous and intramural myomas, myomectomy
found that there was no significant difference in the operative
was carried out the with a serosal incision vertically
time between group using barbed sutures and the group using
over the convex surface of the myoma using a 4
conventional sutures.
monopolar hook.
In another study done by JI Einarsson et al 2011, it was
• After exposure of the myoma pseudocapsule, grasping
found that use of bidirectional barbed suture was found to
forceps were positioned to apply traction to the myoma
significantly shorten the mean (SD) duration of surgery
and expose the cleavage plane.
[118 (53) minutes vs 162 (69) minutes; p < 0.05] when
• Enucleation was carried out by traction on the 12
compared to conventional suturing.
fibroid and by division with a unipolar hook or
In a study conducted by JI Einarsson et al 2011 in animal
mechanical cleavage. model it was found that the mean total procedure time was
• Hemostasis during dissection was achieved by bipolar 11
13.3 minutes.
coagulation. Suturing was usually done along one or
In yet another study done by Roberto Angioli et al
two layers depending on the depth of incision with
2012 it was found that the mean operative time was
barbed sutures or conventional vicryl sutures.
shorter in the V-Loc (51 ± 18.1 minutes) than in the control
• Removal of myoma: Larger myoma were removed 6
(58 ± 17.8 minutes) group.
through posterior colpotomy. Medium and large size
fibroid is morcellated using a morcellator or scissors. INTRAOPERATIVE BLOOD LOSS
For infected and suspected carcinoma, tissue retrieval
In the study done by Franco Alessandri et al 2010 it was
bag should be used.
found that the intraoperative blood loss was significantly
DISCUSSION lower in group using barbed sutures than the group using
conventional sutures (p = 0.004). 4
Time Required for Intracorporeal Suturing (Table 1)
In another study done by JI Einarsson et al 2011 it was
In the study done by Franco Alessandri et al 2010, it was found that there were no significant differences with respect
found that the time required to suture the uterine wall defect to the intraoperative blood loss between barbed and
was significantly lower in group using barbed sutures conventional sutures. 12
(11.5 ± 4.1 minutes) than in the group using conventional In yet another study done by Roberto Angioli et al 2012
sutures (17.4 ± 3.8 minutes; p < 0.001). 4 intraoperative bleeding was found to be significantly lower
In the other study done on animal model by JI Einarsson in the V-Loc group (p = 0.0076). 6
et al 2011 myometrial closure was found to be significantly In the study done by JI Einarsson et al 2010 in an animal
11
faster using barbed suture (126.5 seconds) when compared model found that the mean blood loss was 159 ml.
to traditional suture (272.6 seconds; p < 0.001). 12
FALL IN HEMOGLOBIN LEVELS
In yet another study done by Roberto Angioli et al 2012
it was found that suturing time was found to be significantly In a study done by Roberto Angioli et al 2012, drop in
lower in the V-Loc (Barbed suture) than in the control hemoglobin was found to be significantly lower in the
(9.9 ± 4.3 vs 15.8 ± 4.7 minutes; p = 0.0004) group. 6 V-Loc group (p = 0.0176). 6

Table 1: Time needed for intracorporeal suturing
Study Barbed sutures Conventional sutures p-value
Franco Alessandri et al 2010 11.5 ± 4.1 mins 17.4 ± 3.8 mins <0.001
JI Einarsson et al 2011 126.5 seconds 272.6 seconds <0.001
Roberto Angioli et al 2012 9.9 ± 4.3 mins 15.8 ± 4.7 mins = 0.0004

Table 2: Total duration of surgery
Study Barbed sutures Conventional sutures p-value
Franco Alessandri et al 2010 No significance difference
JI Einarsson et al 2011 118 minutes 162 minutes <0.05
Roberto Angioli et al 2012 51 ± 18.1 mins 58 ± 17.8 mins NA

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