title: Vaginal cuff closure during robotic-assisted total laparoscopic hysterectomy: comparing vicryl to barbed sutures.
abstract: OBJECTIVE
  Empirical evidence is needed to assess clinical appropriateness of any new surgical device or material. Differences in surgical outcomes between Vicryl figure-of-8 and V-Loc barbed sutures for vaginal cuff closure during robotic hysterectomy were assessed.
  
  
  METHODS
  We examined the electronic medical records of 202 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures, between January 2008 and November 2010 at the Henry Ford Health System academic medical center. Cuff closure approach was selected by the surgeon. Data on demographics, vaginal cuff suture type, body mass index (BMI), estimated blood loss (EBL), perioperative hemoglobin change, procedure duration, hospital length of stay (LOS), specimen weight, and postoperative complications were obtained.
  
  
  RESULTS
  The average age was 46 y (SD = 8.0 y). Women with Vicryl figure-of-8 closures (n = 133) were more likely than women with V-Loc barbed suture closures (n = 69) to have had a LOS > 1 d (48/133, 36.1% vs. 12/69, 17.4%; chi square P < .006), greater EBL (median 75 vs. 50 mL, Wilcoxon Rank Sum WRS P < .001), and longer procedure durations (175 vs. 135 min, WRS P < .001). These differences persisted even after considering uterine weight, BMI, smoking status, and concomitant oophorectomy. No differences with respect to the frequency of major (2 in each closure type) or minor complications were observed (P < .36).
  
  
  CONCLUSIONS
  There were no differences in complications between the Vicryl figure-of-8 and V-Loc barbed sutures in our sample. However, the latter had lower EBL and shorter procedure duration and LOS.
authors.affiliation: Department of Gynecology, Obstetrics, and Women's Health, Henry Ford Hospital, Detroit, MI, USA. k_nawfal@hotmail.com
authors.forename: A Karim
authors.initials: AK
authors.lastname: Nawfal
authors.forename: David
authors.initials: D
authors.lastname: Eisenstein
authors.forename: Evan
authors.initials: E
authors.lastname: Theoharis
authors.forename: Marisa
authors.initials: M
authors.lastname: Dahlman
authors.forename: Ganesa
authors.initials: G
authors.lastname: Wegienka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D011098:Polyglactin 910; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*
chemical_list: D011098:Polyglactin 910