title: In vivo assessment of an absorbable and nonabsorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture.
abstract: BACKGROUND
  Laparoscopic intracorporeal suturing and knot tying is a complex skill that requires repeated deliberate practice to master. A novel self-anchoring barbed suture material that does not require knot tying can eliminate knot failure and reduce operating time. The goal of this study was to compare the in vivo efficacy of two novel knotless barbed sutures (absorbable and nonabsorbable) for use with the Endo Stitch™ device (Covidien), against conventional suture (Endo Stitch device with Polysorb™ suture; Covidien) for laparoscopic closure of viscerotomies in canine stomach, jejunum, and colon.
  
  
  METHODS
  Following Institutional Animal Care and Use Committee approval, 24 dogs underwent laparoscopic creation of 25-mm viscerotomies, three each in the stomach, jejunum, and colon. All viscerotomies were closed with the Endo Stitch device using the absorbable or nonabsorbable barbed suture or conventional suture. Closure time for each viscerotomy was recorded. Animals were survived for 3, 10, or 21 days, at which point the viscerotomies were burst-pressure tested.
  
  
  RESULTS
  The closure leak rate in this study with 216 total viscerotomy closures was 0%. There was no statistically significant difference in mean burst pressure between viscerotomies closed with barbed suture versus control suture at any of the survival intervals. Barbed suture with the Endo Stitch device was associated with statistically significantly faster closure times than the control suture with the Endo Stitch device (P<.05), resulting in a reduction in closure time between 35% and 42%.
  
  
  CONCLUSIONS
  This study reports the first use of barbed suture for the Endo Stitch device in laparoscopic gastrointestinal closure. The barbed suture for the Endo Stitch device is effective for laparoscopic single-layer gastrointestinal closure and is associated with a significantly reduced closure time.
authors: Division of Minimally Invasive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Philip
authors: P
authors: Omotosho
authors: Basil
authors: B
authors: Yurcisin
authors: Eugene
authors: E
authors: Ceppa
authors: Jeffrey
authors: J
authors: Miller
authors: David
authors: D
authors: Kirsch
authors: Dana D
authors: DD
authors: Portenier
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D004285:Dogs; D010535:Laparoscopy / Q000379:methods*; D008422:Materials Testing; D013537:Sutures
chemical_list: D001672:Biocompatible Materials