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Computer-Assisted Laparoscopic Myomectomy
Published in John C. Petrozza, Uterine Fibroids, 2020
Randi H. Goldman, Antonio R. Gargiulo
Barbed suture is now routinely used to close the deep myometrial and even the serosal layers. Barbed suture provides appropriate tissue tension and re-approximation of surgical planes and allows for a faster closure (and less blood loss) [38,39,54,55]. Once hemostasis is confirmed, we routinely apply an adhesion barrier such as Interceed to hysterotomy sites, to further reduce the risk of postoperative adhesion formation [56].
Robot-Assisted Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Arnold P. Advincula, Chetna Arora
The leiomyomas are then placed aside within the pelvis or strung onto a barbed suture to avoid loss within the abdomen while the uterine incisions are closed. Closure is mirrored from the traditional open technique as the same surgical principles apply. The hysterotomies are then rapidly sutured from the inside-out, and often a two- or three-layer closure is performed if the endometrium is not disturbed [31]. If there is concern for a breach in the endometrium, methylene blue can be injected directly into the uterine manipulator. If a defect in the endometrium is present, the methylene blue that distends the uterine cavity extrudes within the abdomen. Closure of this space can be carried out with a separate suture layer. As the majority of the blood loss is from disruption of the myometrium and uterine sinuses, hemostasis is obtained by swift closure with suture and occasional (but sparing) use of diathermy. The goal should be minimal use of energy in an effort to decrease myometrial necrosis and thus possible obstetric sequelae such as uterine rupture [32, 33]. The uterine incisions can be closed with either barbed or nonbarbed delayed absorbable monofilament sutures. The barbed suture contains small helically arranged hooks that grasp the tissue and maintain tension. Barbed suture is the preference at our institution given that it allows a significantly shorter operating time and lower estimated blood loss and eliminates the need for surgical knots [34, 35]. Once the myometrial defect has been repaired, the serosa should already be largely approximated so that closure is off-tension and hemostatic. Closure of this layer eliminates raw tissue exposure, and imbrication techniques bury the suture, thus lessening possible foreign body reactions and adhesions [32] (Figure 9.5).
Analysis of study designs and primary outcome measures in clinical trials of investigational suture materials
Published in Expert Review of Medical Devices, 2022
Nahathai Dukaew, Wannachai Sakuludomkan, Mingkwan Na Takuathung, Dumnoensun Pruksakorn, Winita Punyodom, Nut Koonrungsesomboon
Fourth, the correlation network and heatmap analysis point out common endpoints to be set as primary outcome measures for particular types of investigational suture materials. For instance, in clinical trials evaluating barbed vs non-barbed suture materials, suturing time has been commonly used as a primary outcome measure. This observation is conceivable since most barbed suture materials are often developed to serve to anchor the tissue without the knot tying [75]. As a result, many clinical trials have been designed to evaluate the utility of novel barbed suture materials based on the assumption that surgeons would require less suturing time with barbed suture materials when compared to traditional smooth (non-barbed) suture materials. For another example, all the trials investigating antibacterial-coated suture materials had the incidence of wound infection or bacterial accumulation at the wound surface as a primary outcome measure. This observation is simply conceivable because such suture materials are often developed with the primary aim of reducing the occurrence of wound infection following surgical procedures [21,76]. As such, the choice of primary outcome measures is trial-specific, largely depending on the type of investigational suture materials.
Simple dural closure using a knotless barbed suture in endoscopic transsphenoidal surgery: preliminary experience
Published in Acta Oto-Laryngologica, 2019
Zixiang Cong, Handong Wang, Chiyuan Ma
All surgeries were performed through the binostril endoscopic endonasal transsphenoidal approach. The dura was cross incised and then the lesion was removed. Sellar repair was performed according to the degree of intraoperative CSF leak. In the cases of low-flow CSF leak (grade 1 and 2), we used the absorbable gelatin sponge for sellar packing and then suture the sellar floor dura. A 4-0 unidirectional barbed suture (Stratafix, Ethicon, Somerville, NJ) was used for suturing. The suturing process was shown in Figure 1. The first stitch was placed at the top left corner and secured by passing through a looped end. The remaining three corners were successively stitched in the anti-clockwise sequence. The last stitch returned to the top left corner. No knot was made in the procedure of dural suturing. In the cases of high-flow CSF leak (grade 3), multilayer reconstruction including dural suture was performed (Figure 2). An absorbable artificial dura mater was placed on the arachnoid defect. Sellar packing was performed with the absorbable gelatin sponge or autologous fatty tissue and then the corners of dura were sutured together using a unidirectional barbed suture. The sutured dura was sequentially covered with the nasoseptal flap. Each layer is secured with fibrin glue. In addition, in some cases without intraoperative CSF leak (grade 0), we also routinely sutured dura to restore anatomic structure and improve suturing technique.
Oblique intradermal suture as a faster choice for intradermal closure: a randomized equivalence trial
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Apinut Wongkietkachorn, Nuttapone Wongkietkachorn, Peera Rhunsiri
The OIS method reduced the time needed to suture by 50%. This reduction is mostly attributable to the 50% reduction in the number of stitches, as OIS stitches take just as long to make and tie as IS stitches. This reduction in the number of stitches required is one of the most pronounced advantages of this technique over other novel interrupted intradermal techniques [1–5]. The only difference between OIS and IS is the angled suturing pattern, with all other movements being the same between methods. Open surgical procedures can also benefit from OIS. It was reported that the average deep dermal closure in abdominal and breast procedures was 10.1 min [17]. The use of OIS might be able to reduce suture time to almost the level achieved when using barbed suture (barbed suture 4.9 vs. IS 10.1 min) [17]. However, barbed suture is more expensive than conventional absorbable suture [18,19]. OIS can be an efficient alternative, with lower costs realized from the need for less stitches, which requires less time and less suture material.