1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.
Obstet Gynecol. 2024 Oct 1;144(4):e81-e100. doi: 10.1097/AOG.0000000000005695. Epub 2024 Aug 15.
To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies.
We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024.
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures).
TABULATION, INTEGRATION, AND RESULTS: The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference -12.04 minutes, 95% CI, -16.94 to -7.14, P <.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference -6.04 minutes, 95% CI, -7.43 to -4.65, P <.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference -0.40 g/dL, 95% CI, -0.72 to -0.09, P <.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference -47.22 mL, 95% CI, -78.54 to -15.90, P =.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19-1.00, P =.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference -1.66 95% CI, -2.37 to -0.94, P <.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates.
The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies.
PROSPERO, CRD42023477304.
基于与传统缝线研究的比较，积累目前关于无结带刺缝线在腹腔镜子宫肌瘤剔除术中重建子宫壁的安全性和有效性的可用文献。
我们检索了 PubMed/Medline、Scopus、ClinicalTrials.gov 和 Google Scholar，检索时间截至 2024 年 2 月 29 日。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南和 PICO 标准，我们纳入了所有评估接受腹腔镜子宫肌瘤剔除术且使用带刺或传统（体外或体内缝线）修复子宫壁缺损的患者围手术期结局的英文全文文章。
表格、综合和结果：使用带刺缝线可显著缩短手术时间（2111 例患者，平均差值-12.04 分钟，95%置信区间，-16.94 至-7.14，P<.001）。当单独分析缝合时间时也反映了这一点（437 例患者，平均差值-6.04 分钟，95%置信区间，-7.43 至-4.65，P<.001）。带刺缝线组术前和术后血红蛋白水平的平均差值显著较低（1277 例患者，平均差值-0.40g/dL，95%置信区间，-0.72 至-0.09，P<.01）。在估计的失血量方面也观察到了这种情况，带刺缝线组的失血量较低（1823 例患者，平均差值-47.22mL，95%置信区间，-78.54 至-15.90，P=.003）。最后，带刺缝线组的输血率较低（1217 例患者，比值比 0.43，95%置信区间，0.19-1.00，P=.05）。
关于手术难度的外科医生评估的视觉模拟量表（VAS）评分，对照组与带刺缝线组相比被证明更具技术挑战性（184 例患者，平均差值-1.66，95%置信区间，-2.37 至-0.94，P<.001）。两组患者术后 24 小时的 VAS 疼痛评分、术后并发症发生率和住院时间相似。关于生殖结局，妊娠、活产和出生并发症发生率无差异。
在腹腔镜子宫肌瘤剔除术中使用带刺缝线，在手术和缝合时间、估计失血量和易用性方面为患者和外科医生带来了许多临床益处。这项开创性技术可能有助于腹腔镜技术在更复杂的子宫肌瘤剔除术中的应用。
PROSPERO，CRD42023477304。
