title: Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta-analysis.
abstract: As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = -8.52, 95% confidence interval (CI) = -12.60 to -4.43, p < 0.0001] and length of hospital stay (MD = -0.96, 95% CI = -1.80 to -0.11, p = 0.03) were significantly shorter in the barbed group. Results of continence rate varied according to different studies. Subgroup analysis by type of MIRP suggested that patients who underwent barbed suture during robot-assisted surgeries had a shorter hospital stay (MD = -1.13, 95% CI = -1.82 to -0.45, p = 0.001). During the laparoscopic surgery, patients in the barbed suture group had fewer postoperative complications [odds ratio = 0.29, 95% CI = 0.08-0.98, p = 0.05). However, more evidence is needed to validate this state-of-the-art technology.
authors.affiliation: West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Yi-Fei
authors.initials: YF
authors.lastname: Lin
authors.affiliation: West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Si-Ke
authors.initials: SK
authors.lastname: Lai
authors.affiliation: West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Qin-Yu
authors.initials: QY
authors.lastname: Liu
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Bang-Hua
authors.initials: BH
authors.lastname: Liao
authors.affiliation: West China Hospital, Sichuan University, Chengdu, China. Electronic address: michael_huangjin@163.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Huang
authors.affiliation: West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Du
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Kun-Jie
authors.initials: KJ
authors.lastname: Wang
authors.affiliation: West China School of Medicine, Sichuan University, Chengdu, China; Department of Urology, West China Hospital, Sichuan University, Chengdu, China; West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
keywords: Prostatectomy; Surgical technique; Systematic review