title: The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety.
abstract: BACKGROUND
  Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.
  
  
  OBJECTIVE
  The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.
  
  
  METHODS
  We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).
  
  
  RESULTS
  Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45--4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52--0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6-12 months after surgery.
  
  
  CONCLUSIONS
  Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China; Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Huixin
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Haibin
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Tangxuan
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Zhenquan
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China.
authors.forename: Taolin
authors.initials: T
authors.lastname: Xia
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D061646:Operative Time; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation; D012669:Seminal Vesicles / Q000601:surgery; D013536:Suture Techniques / Q000295:instrumentation* / Q000534:rehabilitation; D013537:Sutures; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery