title: Unidirectional barbed suture versus interrupted vicryl suture in vaginal cuff healing during robotic-assisted laparoscopic hysterectomy.
abstract: This study examined the performance of unidirectional barbed suture versus polyglactin 910 with respect to vaginal cuff healing in robotic-assisted total laparoscopic hysterectomy (RATLH). This was a retrospective cohort study of 93 patients who underwent RATLH in a teaching hospital from July 2008 to June 2012. In the first 44 patients, the vaginal cuff was closed by interrupted polyglactin (Vicryl) 2-0 suture. In the following 49 patients, unidirectional barbed suture (V-loc) in a running fashion was used for cuff closure. Patients were seen 2 and 6 weeks postoperatively to evaluate cuff healing. Age, tobacco use, hemoglobin, deliveries, uterine weight, menopause, steroid use, underlying health problems, and concomitant procedures were found not to be significantly different between the two groups. There was one cuff dehiscence in the unidirectional barbed suture group and none in the interrupted polyglactin group (P > 0.05). The mean cuff healing time (8.5 vs. 7.7 weeks), incidence of cuff cellulitis (4.6 vs. 4.1 %), and postoperative bleeding (22.7 vs. 14.3 %) were not statistically significantly different between polyglactin and barbed suture closures, respectively (P > 0.05). However, polyglactin suture was associated with greater presence of granulation tissue than barbed suture (27.3 vs. 8.2 %, odds ratio = 3.34, P < 0.05). Unidirectional barbed suture cases were associated with shorter total operative times (220.2 vs. 272.8 min) and less estimated blood loss (164.8 vs. 274.9 ml); however, cuff closure times were not specifically measured. In our study, unidirectional barbed suture was identified as possibly superior to polyglactin cuff closure because of less observed granulation tissue, shorter operative duration, and lower estimated blood loss. However, there was no statistical difference in cuff healing time, cuff dehiscence, cellulitis, or postoperative bleeding between the two groups. A prospective randomized trial would be necessary to confirm these findings.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, USA.
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, USA.
authors.forename: Greer
authors.initials: G
authors.lastname: Guthrie
authors.affiliation: School of Public Health, University of Texas Health Science Center, Houston, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Chuang
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, USA. faro.jonathan@gmail.com.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Faro
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, USA.
authors.forename: Vaseem
authors.initials: V
authors.lastname: Ali
keywords: Robotic-assisted total laparoscopic hysterectomy; V-loc; Vaginal cuff healing; Vicryl