title: Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction.
abstract: OBJECTIVE
  To evaluate a novel prototype self-anchoring suture (SAS) material that incorporates unidirectional "barbs" designed to grip and approximate tissue without the need for suture ligation for urinary tract reconstructive procedures.
  
  
  METHODS
  The in vitro failure strength of various porcine tissue approximations with SAS was compared with the strength of similar approximations with standard ligated suture. For in vivo analysis, 3 pigs underwent laparoscopic pyeloplasty with SAS on one side and 2-0 Vicryl suture on the contralateral side. Nine pigs underwent bladder neck anastomoses (BNA) performed with SAS (n = 3) and standard ligated interrupted suturing (n = 3) or standard ligated running suturing (n = 3). The operative times were compared. One week after surgery, the integrity of each anastomosis was evaluated radiographically and histopathologically.
  
  
  RESULTS
  The in vitro analysis revealed no statistically different (P = 0.22) failure forces between the approximations performed with SAS (13.2 +/- 2.6 N) and standard suture (14.1 +/- 3.1 N). The in vitro analysis revealed no difference in operative times for the pyeloplasties (P = 0.72) or BNA (P = 0.31). None of the 1-week postoperative radiographic studies revealed extravasation. The histopathologic analysis revealed more fibrotic reaction associated with the SAS BNA procedures (P <0.01).
  
  
  CONCLUSIONS
  Self-anchoring suture secures tissue approximations at loads equivalent to tissue approximations with standard tied suture. Self-anchoring suture obviates the need for knot tying and provides a watertight anastomosis. With laparoscopic knot tying experience, anastomotic time with SAS and standard suture do not differ. Self-anchoring suture might induce more fibrosis. Long-term follow-up evaluation will be required before clinical application.
authors.affiliation: Division of Urology and Department of Pathology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Weld
authors.forename: Caroline D
authors.initials: CD
authors.lastname: Ames
authors.forename: Greg
authors.initials: G
authors.lastname: Hruby
authors.forename: Peter A
authors.initials: PA
authors.lastname: Humphrey
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000818:Animals; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013520:Urologic Surgical Procedures / Q000379:methods*