Use Of Bidirectional Barbed Suture In Gynecologic Laparoscopy
Background: Laparoscopic suturing and knot tying can be a challenging and time-consuming task. We began using a bidirectional barbed suture for laparoscopic suturing in March of 2008, mainly for closure of the vaginal cuff during a total laparoscopic hysterectomy and for closure of the hysterotomy site during a laparoscopic myomectomy. Since then, we have performed well over 100 cases using this suture material with excellent results.
Methods: The suture has a needle on each end with small barbs incorporated into the suture. The barbs run in the opposite direction to the needles, similar to the concept of an arrowhead. This ensures that the suture slides easily through the tissue, but will not slide back. The wound closure tension is thereby evenly distributed throughout the suture as opposed to only at the ends. In addition, because the barbs coming from each needle are running in opposite directions, there is no need to tie knots at the end of the suture. The lack of backsliding is especially useful in myomectomy closures where there is frequently high tension on the closure site.
Results: In our experience, this suture material greatly facilitates laparoscopic suturing and results in a secure and hemostatic closure.
Conclusion: We present our laparoscopic suturing technique with this novel suture material for vaginal cuff closure and hysterotomy closure in this video.
Authors: Jon Ivar Einarsson, MD, MPH, James A. Greenberg, MD