Bogliolo Stefano, Musacchi Valentina, Dominoni Mattia, Cassani Chiara, Gaggero Chiara Roberta, De Silvestri Annalisa, Gardella Barbara, Spinillo Arsenio
Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy,
Arch Gynecol Obstet. 2015 Sep;292(3):489-97. doi: 10.1007/s00404-015-3653-x. Epub 2015 Feb 21.
Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological procedures nowadays. Minimally invasive procedures seem to increase the risk of vaginal cuff dehiscence (VCD). Barbed suture is a new class of suture introduced to aid surgeons during laparoscopic suturing, with the aim to reduce operative time, blood loss, and vaginal dehiscence.
We identified all articles that report a series of laparoscopic or robotic-assisted hysterectomy using barbed suture compared to conventional suture for vaginal cuff closure. The main outcome measures were vaginal cuff suturing time, vaginal bleeding, and vaginal dehiscence with or without small bowel evisceration. Suturing time was meta-analyzed as the standardized mean difference, which is the difference in means of two arms divided by pooled standard deviation with 95 % confidence intervals. For vaginal bleeding and dehiscence risk difference were calculated for each study and then meta-analyzed. Fixed models were considered if heterogeneity was low (I (2) < 50 %), otherwise random models were preferred.
We show that minor bleeding (RD = 0, 95 % CI 0.03-0.03; p value = 0.907) and VCD (RD = -0.01, 95 % CI 0.02-0.00; p value = 0.119) are comparable in minimally invasive hysterectomy with or without the use of barbed suture. The major bleeding (RD = -0.03; 95 % CI 0.05-0.00; p value = 0.047) appears borderline significant, but the difference between the two types of sutures is not high and the upper limit of 95 % IC is equal to 0 so they were considered comparable. Instead, meta-analysis on vaginal cuff suturing time demonstrates that suturing time is reduced with the use of barbed suture (SMD = -0.96, 95 % CI 1.26-0.70; p value <0.001).
Barbed suture is safe and well tolerated as traditional sutures and is associated with reduced operative time of laparoscopic vaginal vault closure.
全腹腔镜或机器人辅助子宫切除术是目前最常施行的妇科手术之一。微创手术似乎会增加阴道残端裂开（VCD）的风险。倒刺缝线是一类新型缝线，旨在辅助外科医生进行腹腔镜缝合，以减少手术时间、出血量和阴道裂开。
我们检索了所有报告一系列使用倒刺缝线与传统缝线进行阴道残端闭合的腹腔镜或机器人辅助子宫切除术的文章。主要观察指标为阴道残端缝合时间、阴道出血以及有无小肠脱出的阴道裂开情况。缝合时间采用标准化均数差进行荟萃分析，标准化均数差即两组均值之差除以合并标准差，并给出95%置信区间。对于阴道出血和裂开，计算每项研究的风险差异，然后进行荟萃分析。若异质性较低（I²<50%），则采用固定模型，否则优先选择随机模型。
我们发现，在使用或未使用倒刺缝线的微创手术中，轻微出血（风险差异=0，95%置信区间0.03 - 0.03；p值=0.907）和VCD（风险差异=-0.01，95%置信区间0.02 - 0.00；p值=0.119）相当。严重出血（风险差异=-0.03；95%置信区间0.05 - 0.00；p值=0.047）似乎接近显著，但两种缝线之间的差异不大，95%置信区间的上限等于0，因此认为它们相当。相反，对阴道残端缝合时间的荟萃分析表明，使用倒刺缝线可减少缝合时间（标准化均数差=-0.96，95%置信区间1.26 - 0.70；p值<0.001）。
倒刺缝线与传统缝线一样安全且耐受性良好，并且与腹腔镜阴道穹窿闭合手术时间的减少有关。
