The use of barbed suture in hysterectomy and myomectomy.

Standard sutures used in vaginal cuff reapproximation in total laparoscopic hysterectomies and hysterotomy closure in myomectomies require knot placement and tensioning of the suture throughout the closure. This may contribute to wound dehiscence, increased blood loss, and ischemia of tissue surrounding the knots. In 2004, the United States Food and Drug Administration approved the Quill™ bidirectional barbed suture (Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada)(Fig. 1). In January 2007, the suture was introduced in the United States. The emergence of the bidirectional barbed suture has significantly affected minimally invasive surgery. Initially used by orthopaedic and plastic surgeons, barbed suture has allowed for the tedious task of knot tying to fade away. Following the introduction of the bidirectional barbed suture, the FDA approved the V-Loc™ unidirectional suture (Covidien, Mansfield, MA)(Fig. 2). The utility of the barbed suture has been instrumental in laparoscopic myomectomy and total laparoscopic hysterectomy. As barbed suture is easily utilized using the same laparoscopic ports, needle drivers, and graspers, the surgeon does not require a third hand to facilitate laparoscopic suturing. The barbs minimize tissue recoil and do so with accurate soft tissue approximation, achieving hemostasis without the use of locking and figure eight sutures. Barbed suture allows for a shorter operative time, as there is an ease of suturing without the complication of knot tying. Barbed sutures are essential tools in the modern laparoscopist's toolbox.