Comparison of Polyglactin 910 With Barbed Sutures for Vaginal Cuff Closure Time in Patients Undergoing Total Laparoscopic Hysterectomy.

Background Total hysterectomy is among the most performed gynecological surgeries globally, with a significant shift toward laparoscopic approaches for benign uterine conditions. While laparoscopic hysterectomy offers several benefits, such as reduced pain, shorter recovery, and fewer complications, challenges in laparoscopic suturing of the vaginal cuff remains. The introduction of barbed sutures, which eliminate the need for knotting, has been proposed as an effective alternative to traditional suturing. Methods A prospective, two-arm, randomized, single-center study was conducted at Adichunchanagiri Institute of Medical Sciences, Karnataka, India, from May to October 2024. Sixty adult women, aged 30-75 years, scheduled for total laparoscopic hysterectomy (TLH) due to benign uterine pathologies were enrolled. Participants were randomly assigned to one of two groups using a pre-sealed envelope: the unidirectional barbed suture group with a triangular end stopper and a black needle or the polyglactin 910 suture group with a black needle. Primary and secondary outcomes included comparison of vault closure time, total operative time, postoperative pain (measured by the visual analog scale), intraoperative handling of sutures, and vaginal cuff-related complications. Results The barbed suture group had a significantly shorter mean vault closure time (6.94 ± 3.39 minutes vs 11.75 ± 4.59 minutes; p = 0.00002) and total operative time (102.27 ± 22.27 minutes vs 131.10 ± 24.99 minutes; p = 0.000015) as compared to the polyglactin 910 suture group. Postoperative pain levels and intraoperative handling properties of the sutures were comparable between the two groups. No vaginal cuff-related complications were observed in either group. Conclusion The barbed suture significantly reduced vault closure time and total operative time compared to the polyglactin 910 suture, suggesting that it may enhance the efficiency of laparoscopic vaginal cuff closure. However, both suture types demonstrated comparable postoperative pain and complication rates. These findings support the use of both sutures as safe and effective options for TLH, with the barbed suture offering advantages in vault closure time and overall surgical time.