title: Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery.
abstract: BACKGROUND
  The application of minimally invasive surgery (MIS) for advanced procedures in children is logical. However, the intracorporeal placement and tying of suture can be challenging, leading to prolonged anesthesia and morbidity. We describe our initial experience with the use of a novel unidirectional barbed knotless suture (V-LOC, Covidien, Mansfield, MA) that permits a safe and efficient advanced MIS reconstruction in infants and children.
  
  
  METHODS
  From August 2010 to February 2012, 11 infants and children underwent diaphragmatic reconstruction utilizing either the absorbable or the permanent V-LOC suture. Data retrieval included gender, weight, diagnosis, operative time, complications and follow up.
  
  
  RESULTS
  Thoracoscopic or laparoscopic repairs were carried out in all children. Two of the infants with congenital diaphragmatic hernia of Bochdalek (CDH) developed a recurrence at 4 and 6 months of age and required reoperation. There were no other complications or recurrence in the remaining 9 children, and there were no mortalities in the group.
  
  
  CONCLUSIONS
  This is the first study to evaluate the use of the unidirectional barbed knotless suture in pediatric surgery. We demonstrate that the use of the V-LOC barbed suture is an innovative, safe and time saving option for pediatric MIS. Prospective analysis with long-term follow-up is required to confirm these initial results and to ascertain if this novel approach can be utilized in other pediatric surgical conditions.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA. jlukish1@jhmi.edu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lukish
authors.forename: Sara
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Deidra
authors.initials: D
authors.lastname: Garrett
authors.forename: Dylan
authors.initials: D
authors.lastname: Stewart
authors.forename: James
authors.initials: J
authors.lastname: Buck
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Paul
authors.initials: P
authors.lastname: Colombani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D010865:Pilot Projects; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013537:Sutures; D013906:Thoracoscopy; D016896:Treatment Outcome
keywords: Diaphragmatic repair; Minimal access surgery; Pediatric surgery; V-LOC