title: In-vivo assessment of barbed suturing thread with regard to tissue reaction and material absorption in a rat model.
abstract: OBJECTIVE
  The laparoscopic approach in urological surgery demands a high degree of skill in intracorporeal suturing and knot tying. In an effort to reduce the amount of time required to perform a suture, new materials have been developed that through selfanchorage distribute tension more evenly across the suture and also eliminate the need of knot tying. The goal of this study was to assess the in vivo tissue response to a novel material (V-Loc tm; Covidien) in comparison to established materials (Vicryl, PDS II), in the case of bladder suturing, in a rat model.
  
  
  METHODS
  The study included 48 male Wistar rats. All underwent a median abdominal incision, with a 1cm cystotomy, followed by a running suture. The suture material used was either V-Loc absorbable self anchoring thread, Vicryl threaded absorbable suture or monofilament absorbable suture. The abdominal cavity and the bladder suture were macroscopically evaluated at the rats' scheduled death at 3 and 6 weeks. The bladder wall was microscopically assessed by a pathologist, with regard to tissue reaction and suture material degradation.
  
  
  RESULTS
  All rats survived the procedure, with the abdominal scar fully healed at week 2. There were no signs of infection or lithiasis during the observation. Macroscopically, at 3 weeks, the suture material was recognizable and visible in all cases, with special mention that the V-Loc thread was considerably more rigid, retaining its shape almost entirely, and provoked more adhesion of the surrounding tissue. At 6 weeks, the suture was indistinguishable in the bladder wall in the case of monofilament absorbable material, barely visible in the case of Vicryl, while the aspect of the V-Loc suture resembled the one at 3 weeks, with the material still clearly visible in the bladder wall, shape almost entirely maintained, and surrounding tissue adherence. Microscopically, at 3 weeks and 6 weeks, all bladder walls examined had regained their structure. At 3 weeks, the monofilament absorbable suture showed intense tissue reaction, with the material already in phagocytosis; at 6 weeks, no clear evidence of leftover material was observed. At 3 weeks, the Vicryl material showed moderate tissue reaction, with phagocytosis initiated between the strands of the material; at 6 weeks, the material was almost entirely absorbed, but with a clear leftover tissue reaction. In the case of the V-Loc suture, due to the hardness of the thread, the material itself could not be cut for analysis with the bladder wall, and the examination could only involve the bladder wall and marks of the thread. Thus, the tissue reaction was minimal, as was the presence of phagocytes at the suture site. The material showed little, if any, signs of absorption after 6 weeks.
  
  
  CONCLUSIONS
  The materials tested all proved equally effective in suturing the bladder wall in a rat model. However, the novel barbed thread proved a consistently low in-vivo absorption rate, while maintaining its rigidity over time. More research is needed to assess the possible clinical implications of these findings.
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Petrut
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Maximiliam
authors.initials: M
authors.lastname: Hogea
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Fetica
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Andrei
authors.initials: A
authors.lastname: Kozan
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Feflea
authors.affiliation: Department of Urology, Oncological Institute Cluj Napoca, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sererman
authors.affiliation: SLK Klinikum Heilbronn, affiliated to the University of Heidelberg, Germany.
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Goezen
authors.affiliation: SLK Klinikum Heilbronn, affiliated to the University of Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
keywords: V-lok suture; barbed suture; wound healing