Page 14 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Barbed vs Polyglactin 910: A Comparative Study of the

Efficacy in Laparoscopic Vaginal Cuff Closure

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Prathap Talwar , Lakshmi Velayudam , Hema PL Kukreja , Soumya R Patil 4
AbstrAct
Context: Total laparoscopic hysterectomy (TLH) is a popular mode of hysterectomy in the recent times. One of the principal steps is vaginal cuff
closure, with many variations in surgical technique and materials. Intracorporeal suturing and knot-tying are crucial steps and are considered
to be the most technically difficult skills. To overcome these challenges and learning curve, various measures have been emerging. One among
them is the introduction of barbed suture, a new class of suture material.
Aim: To evaluate whether the use of barbed suture for vaginal cuff closure during TLH reduced the surgical difficulty and suturing time when
compared to polyglactin 910 suture.
Materials and methods: This randomized comparative study included 100 patients divided into two groups of 50 each, who underwent TLH
with vault closure using either barbed sutures or polyglactin 910. Demographic details, indication for surgery, intraoperative complications,
mean suturing time, surgeon difficulty, and average hospital stay were compared between the two groups.
Statistical analysis: Student t test for continuous variables and Fischer exact test for categorical variables. p values ≤ 0.05 were considered
significant.
Results: Use of barbed suture has significantly reduced the suturing time for vaginal vault closure (5.39 vs 6.9 minutes, p value < 0.0001) as well
as the technical difficulty in laparoscopic suturing (p value < 0.0001) when compared to that with polyglactin 910.
Conclusion: The introduction of barbed sutures for vault closure during TLH not just reduces the suturing time but is also technically less
demanding, making it a potential asset in laparoscopic hysterectomies.
Keywords: Barbed suture, Polyglactin 910, Total laparoscopic hysterectomy, Vault closure.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1415

IntroductIon 1–4 Department of Obstetrics and Gynaecology, JSS Medical College

Hysterectomy is the most frequently performed gynecological and Research Institute, Mysuru, Karnataka, India
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surgery in the world. This procedure can be performed through Corresponding Author: Soumya R Patil, Department of Obstetrics
abdominal, vaginal, or laparoscopic access. Besides, robotic-assisted and Gynaecology, JSS Medical College and Research Institute, Mysuru,
laparoscopy and single-port hysterectomy have been developed Karnataka, India, Phone: +91 9739667595, e-mail: soumyarpatil999@
in the recent years. gmail.com
Harry Reich performed the first laparoscopic hysterectomy How to cite this article: Talwar P, Velayudam L, Kukreja HPL, et al.
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in 1988 in Pennsylvania. Since then, laparoscopic hysterectomy Barbed vs Polyglactin 910: A Comparative Study of the Efficacy in
has proven to be a safer choice than traditional surgery for benign Laparoscopic Vaginal Cuff Closure. World J Lap Surg 2020;13(3):
gynecological conditions. The progress in the field of minimally 113–116.

invasive surgery has transformed laparoscopic hysterectomy into Source of support: Nil
most popular mode of hysterectomy in the recent times due to its Conflict of interest: None
cosmetic superiority, shorter hospital stay, quicker resumption of
day-to-day activities, and reduced morbidity. 3 vault dehiscence, the knots performed laparoscopically should be
In total laparoscopic hysterectomy, there are significant as safe as the traditional approach.
variations in the vaginal cuff closure with respect to mode of However, intracorporeal suturing and knot tying are considered
suturing, suturing technique, and suture materials used. Vaginal to be the most technically difficult skills. The fundamentals of a
vault closure is done by intracorporeal sutures or transvaginal perfect knot-tying demands easiness, rapid execution, tight knot,
sutures, by continuous or interrupted sutures, and in single or easily reproducible steps, and, also very importantly, the type
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double layers using knotted or unknotted stitches. Although of suture material used. Performing this laparoscopically is most
widely used, conventional sutures may become loose or entangled, challenging and necessitates adequate skill and experience.
requiring constant traction by an assistant or the operating surgeon, Therefore, it becomes essential to seek a more convenient
all of which may cause instrument collision and tissue tearing technique and safer surgical material to overcome the learning
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leading to prolongation of suturing. Laparoscopic intracorporeal curve required for intracorporeal suturing. One such has been the
closure has several advantages, such as longer postoperative introduction of barbed sutures, which maintain the tensile strength
vaginal length, minimizing granulation tissue as the vault margins evenly along the entire length of the wound and reapproximates
are not everted into the vagina and provide an excellent vault tissue without the use of surgical knot. The favorable results
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support by incorporating the pericervical ring. To prevent vaginal obtained in several studies suggest that the suture material has the

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