Manoucheri Elmira, Einarsson Jon I
Brigham and Women's Hospital Boston, Massachusetts.
Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts.
Surg Technol Int. 2013 Sep;23:133-6.
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.
全腹腔镜子宫切除术中阴道断端重新对合以及子宫肌瘤剔除术中子宫切口关闭所使用的标准缝线，在整个缝合过程中都需要打结并拉紧缝线。这可能会导致伤口裂开、失血增加以及缝线周围组织缺血。2004年，美国食品药品监督管理局批准了Quill™双向倒刺缝线（Angiotech制药公司，加拿大不列颠哥伦比亚省温哥华）（图1）。2007年1月，这种缝线在美国上市。双向倒刺缝线的出现对微创手术产生了重大影响。最初由骨科和整形外科医生使用，倒刺缝线使繁琐的打结任务逐渐被淘汰。在双向倒刺缝线推出之后，美国食品药品监督管理局又批准了V-Loc™单向缝线（柯惠医疗公司，美国马萨诸塞州曼斯菲尔德）（图2）。倒刺缝线在腹腔镜子宫肌瘤剔除术和全腹腔镜子宫切除术中发挥了重要作用。由于使用相同的腹腔镜端口、持针器和抓钳就能轻松使用倒刺缝线，外科医生在腹腔镜缝合时无需第三只手协助。倒刺可最大程度减少组织回缩，并能精确对合软组织，无需使用锁定缝线和8字缝线即可实现止血。倒刺缝线使手术时间缩短，因为缝合简便，且不存在打结并发症。倒刺缝线是现代腹腔镜外科医生手术器械箱中的重要工具。
