Iavazzo Christos, Mamais Ioannis, Gkegkes Ioannis D
IASO Maternity Hospital, Athens, Greece
University of Athens, Athens, Greece.
Surg Innov. 2015 Oct;22(5):528-39. doi: 10.1177/1553350614554235. Epub 2014 Oct 15.
Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.
免打结倒刺缝线是一种创新的缝合材料，可促进腹腔镜手术操作。本研究的目的是考察倒刺缝线在妇科手术领域腹腔镜和机器人手术应用方面的现有证据。我们在PubMed、Scopus和Cochrane数据库中进行了系统检索。该研究共纳入了1991例患者。使用免打结缝线的闭合时间为3.9至13分钟，在每项研究中均短于使用传统缝线的时间。在子宫切除术中，倒刺缝线组的缝合时间显著更短，观察组之间的平均差异为每次手术2.41分钟（95%置信区间，1.23 - 3.59），而在子宫肌瘤切除术中，比较组之间无统计学显著差异。关于子宫切除术中估计的失血量和大出血情况，两组之间未观察到统计学差异，而子宫肌瘤切除术中估计的失血量具有统计学显著性（P = 0.04）。关于子宫切除术中阴道断端裂开情况，未观察到统计学显著差异（1031例患者，比值比 = 1.63；95%置信区间 = 0.37 - 7.25）。这种缝线的主要优点是完全没有结、组织强度沿伤口均匀分布以及手术时间缩短。需要开展更多方法学质量更高的临床试验，以进一步阐明倒刺缝线的缝合优势和术后结局。
