Khoiwal Kavita, Kapoor Nirali, Gaurav Amrita, Kumari Om, Chaturvedi Jaya
Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND.
Cureus. 2021 Apr 2;13(4):e14257. doi: 10.7759/cureus.14257.
Introduction and objective Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-Loc 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy. Methods A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia. Results Demographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups. Conclusions The unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.
引言与目的 腹腔镜下阴道断端缝合及打结是全腹腔镜子宫切除术（TLH）中最具挑战性的步骤，需要手术技巧。本研究的目的是比较单向倒刺缝线（V-Loc 180；柯惠医疗，马萨诸塞州曼斯菲尔德）与传统的聚乙醇酸910缝线（涂层薇乔；柯惠医疗）在接受全腹腔镜子宫切除术的良性子宫疾病患者中用于阴道断端闭合的有效性和安全性。方法 在印度瑞诗凯诗全印医学科学研究所（AIIMS）妇产科进行了一项为期两年的前瞻性观察研究。共有109例计划行TLH的良性子宫疾病患者纳入研究。44例患者采用单向倒刺缝线（V-Loc）进行腹腔镜阴道断端闭合，65例患者采用标准聚乙醇酸910缝线（薇乔）。主要观察指标为阴道断端闭合时间。次要观察指标包括总手术时间、失血量、平均缝线数、术后疼痛感受、住院时间、阴道断端相关并发症及性交困难。结果 除体重指数（BMI）外，两组患者的人口统计学变量和基线特征相似。V-Loc组的平均阴道断端闭合时间（8.84±2.
