Planella Laura Vilar, García Ignacio Rodríguez, Camps Silvia Franco, Barri-Soldevila Pere N, Díaz Silvia Cabrera
Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital General de Catalunya (Drs. Planella and Camps), Sant Cugat del Vallès, Spain.
Epidemiology Unit (García), Gynecology and Reproduction, Dexeus University Hospital, Barcelona, Spain.
J Minim Invasive Gynecol. 2025 Oct;32(10):862-876. doi: 10.1016/j.jmig.2025.06.023. Epub 2025 Jul 9.
This meta-analysis aimed to compare barbed sutures (BS) and conventional sutures (CS) for vaginal cuff closure in total laparoscopic and robot-assisted hysterectomies, evaluating their impact on operative time, suture time, blood loss, postoperative complications, surgical site infections, and granulation tissue formation.
A comprehensive search of the electronic databases PubMed/MEDLINE and Embase was conducted, covering literature published from 2004 to June 2024.
A systematic review and meta-analysis were conducted, including 24 studies comprising 4.593 women (2212 in the BS group and 2.381 in the CS group). Data were analyzed separately for laparoscopic and robot-assisted procedures.
TABULATION, INTEGRATION, AND RESULTS: No significant differences were found in vaginal cuff dehiscence rates between BS and CS in both surgical approaches. In laparoscopic hysterectomies, BS significantly reduced operative time by 8.58 minutes (95% confidence interval [CI], -14.05 to -3.10), suture time by 4.9 minutes (95% CI, -7.16 to -2.65), and estimated blood loss by 5.42 mL (95% CI, -10.71 to -0.12). In robot-assisted hysterectomies, BS significantly reduced operative time (-37.82 minutes; 95% CI, -54.88 to -20.76) and granulation tissue formation (2.61% vs 11.29%, favoring BS; 95% CI, 0.18-1.23). No significant differences were observed in postoperative complications or surgical site infections for either approach.
BS are a safe and effective option for vaginal cuff closure in minimally invasive hysterectomies. They offer significant advantages in laparoscopic procedures by reducing operative time, suture time, and blood loss, whereas in robot-assisted surgeries, they shorten operative time and decrease granulation tissue formation. These findings support the use of BS as a reliable choice for optimizing surgical outcomes.
本荟萃分析旨在比较倒刺缝线（BS）和传统缝线（CS）在全腹腔镜及机器人辅助子宫切除术中用于阴道残端闭合的效果，评估它们对手术时间、缝合时间、失血量、术后并发症、手术部位感染及肉芽组织形成的影响。
对电子数据库PubMed/MEDLINE和Embase进行全面检索，涵盖2004年至2024年6月发表的文献。
进行了一项系统评价和荟萃分析，纳入24项研究，共4593名女性（BS组2212名，CS组2381名）。分别对腹腔镜手术和机器人辅助手术的数据进行分析。
制表、整合及结果：在两种手术方式中，BS和CS在阴道残端裂开率方面均未发现显著差异。在腹腔镜子宫切除术中，BS显著缩短手术时间8.58分钟（95%置信区间[CI]，-14.05至-3.10）、缝合时间4.9分钟（95%CI，-7.16至-2.65），并减少估计失血量5.42毫升（95%CI，-10.71至-0.12）。在机器人辅助子宫切除术中，BS显著缩短手术时间（-37.82分钟；95%CI，-54.88至-20.76）并减少肉芽组织形成（2.61%对11.29%，BS更优；95%CI，0.18 - 1.23）。两种手术方式在术后并发症或手术部位感染方面均未观察到显著差异。
在微创子宫切除术中，BS是阴道残端闭合的一种安全有效的选择。在腹腔镜手术中，BS通过缩短手术时间、缝合时间和减少失血量具有显著优势，而在机器人辅助手术中，BS可缩短手术时间并减少肉芽组织形成。这些发现支持将BS作为优化手术结局的可靠选择。
