Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis.

PURPOSE: One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries. METHODS: We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187. RESULTS: In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation. CONCLUSION: This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.

Endoscopically Assisted Correction of Malpositioned Breast Implants Using Absorbable Barbed Sutures.

INTRODUCTION: Breast implant malpositioning is the second most common reason for revisional breast surgery. Multiple correction methods are suggested, depending on the malposition, but most of the methods, such as the inframammary fold incision, result in additional scars. We performed transaxillary endoscopic breast implant bottoming out corrections and used V-Loc thread for capsulorrhaphy. METHODS: Fourteen patients who underwent correction for breast implant bottoming out after transaxillary breast augmentation were included in this study. Transaxillary endoscopic correction was performed using a V-Loc thread. RESULTS: All the 14 patients were satisfied with the result immediately after surgery. One case of overcorrection and one with implant bottoming out occurred, but did not require additional surgery. CONCLUSIONS: Transaxillary endoscopic bottoming out correction is a useful technique for those individuals who underwent primary transaxillary incisional breast augmentation. V-Loc thread is useful for endoscopic capsulorrhaphy. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Transvesical correction of recalcitrant vesicourethral anastamotic stenosis with buccal graft fixed by automated V-LOC suture].

We present a clinical case of a patient with a post radical robot-assisted prostatectomy recurrent vesicourethral anastamotic stenosis. Successful simplified transvesical correction with buccal mucosa graft fixed by self-anchoring automated V-Loc suture through the needle for epidural anestesia without knot formation was the unique feature of case presented.

The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study.

BACKGROUND: A totally laparoscopic right colectomy could be perceived as a more challenging procedure over a laparoscopic-assisted right colectomy owing to the difficulty of intracorporeal anastomosis and the closure of the enterotomy. The aim of this study is to evaluate the safety and efficacy of the barbed auto-locking absorbable suture for the closure of an anastomotic stapler-access enterotomy during a totally laparoscopic right colectomy. METHODS: From January 2010 to April 2016, data from patients who had undergone a laparoscopic right colectomy in 2 different departments of 2 institutions (the Department of General and Minimally Invasive Surgery, San Camillo Hospital in Trento and the Department of Surgical Specialties and Nephrology, University Federico II in Naples) were retrospectively analyzed. We compared the data of patients in whom the stapler-access enterotomy was closed through a conventional absorbable suture (Group A), with the data of patients in whom a stapler-access enterotomy was closed through a V-Loc 180 suture (Group B). Biometric features and intraoperative and postoperative data were collected and analyzed. RESULTS: The 2 groups (Group A: 40 patients; Group B: 40 patients) were comparable for biometric features and postoperative outcomes. The anastomosing time was lower in Group B. A statistically significant difference was noted in the mean operative time between Groups A and B (Group A = 134.92 ± 34.17; Group B = 120.92 ± 23.27, P = .035). Only one anastomotic leakage per group was recorded, each treated with an anastomosis redo. During the reoperations, we find in both groups an intact stapler-access enterotomy. CONCLUSION: On retrospective analysis, barbed suture appears to be safe and efficient for closure of the stapler-access enterotomy during totally laparoscopic right colectomy.

Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy.

The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p < .05). V-Loc™ 180 unidirectional barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications.

Laparoscopic percutaneous jejunostomy with intracorporeal V-Loc jejunopexy in esophageal cancer.

BACKGROUND: Barbed sutures are widely used in various laparoscopic digestive surgeries. The purpose of this paper is to present our initial experience of laparoscopic percutaneous jejunostomy with unidirectional barbed sutures in esophageal cancer patients and compare it with our early cases using traditional transabdominal sutures. METHODS: A total of 118 esophageal cancer patients who underwent laparoscopic percutaneous jejunostomy were identified in a single institution in Taiwan from June 2014 to May 2016. The authors' traditional technique consisted of using transabdominal sutures with bolsters to fix a jejunum loop onto the anterior abdominal wall. A novel technique was introduced using intracorporeal suturing with knotless unidirectional barbed monofilament absorbable sutures (V-Loc) to attain a seal around the feeding catheter. A comparison between these two techniques was performed. RESULTS: Twenty cases with barbed V-Loc sutures and 98 cases with transabdominal sutures were identified. The V-Loc sutures appeared to reduce peristomal skin ulcers (19.4 vs. 0 %, p = 0.040), postoperative pain scores during the first 24 h (1.8 ± 1.4 vs. 0.9 ± 1.1, p = 0.007) and on postoperative day 2 (1.7 ± 1.4 vs. 1.0 ± 0.8, p = 0.026) when compared to patients receiving transabdominal sutures. The mean suturing time using V-Loc sutures was 22 min (14-60 min). The mean onset to resumption of enteral feeding was 1.8 ± 0.8 days and the mean duration of postoperative hospital stay was 8 ± 5.1 days, both of which were comparable in the two groups. There was no surgical mortality in our series. CONCLUSIONS: In the study cohort, the use of knotless unidirectional barbed sutures instead of traditional transabdominal sutures had similar outcomes and appears to be a feasible option for intracorporeal jejunopexy when performing laparoscopic jejunostomy in patients with esophageal cancer.

Knotless choledochorraphy with barbed suture, safe and feasible.

PURPOSE: To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE). INTRODUCTION: LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses. METHODS: Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded. RESULTS: Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death. CONCLUSION: The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.

Barbed Sutures in Body-Contouring: Outcome Analysis of 695 Procedures in 623 Patients and Technical Advances.

INTRODUCTION: Surgical wound closure is often complicated by suture-related issues. The recent introduction of knotless barbed sutures may address the shortcomings of conventional sutures and offer the additional benefit of reduced operating time. In this paper, we describe our experience with barbed sutures for body-contouring procedures. We share technical insights and evaluate postoperative complications. PATIENTS AND METHODS: A retrospective assessment of prospectively collected data over a period of more than 5 years was undertaken. Six hundred twenty-three consecutive patients underwent 695 body-contouring procedures with barbed suture closure. Patients were followed for at least 12 weeks postoperatively. Patient demographics, operation time as well as suture-related complications, such as wound dehiscence and wound site infection were recorded and analyzed. RESULTS: Barbed sutures can facilitate skin closure, rectus plication, quilting, and deep layer closure in body-contouring procedures. The average operating time in our study cohort was 108 min with reduction mammoplasty being the quickest (94 min) and bodylift (156 min) being the slowest procedure. Sixty-eight patients experienced suture-related complications resulting in an overall complication rate of 9.7 % with thigh lift having the most (15 %) and reduction mammoplasty (7 %) the fewest adverse events. CONCLUSION: The use of barbed sutures allows quick closure of lengthy body-contouring incision lines with low complication rates. Our observations support that barbed sutures are safe, convenient and effective. In our hands barbed sutures appear to be superior to traditional wound-closure techniques in body-contouring procedures. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Barbed suture vs traditional suture in single-port total laparoscopic hysterectomy.

STUDY OBJECTIVE: To compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). DESIGN: Case-control study (Canadian Task Force classification II-2). SETTING: Two institutions. PATIENTS: One hundred two patients with benign uterine disease. INTERVENTIONS: Single-port TLH using barbed suture (n = 43) or traditional suture (n = 59). MEASUREMENTS AND MAIN RESULTS: Patient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5 minutes; p < .001), as well as total operative time (92.0 vs 105.2 minutes; p = .002). Use of barbed suture is less technically demanding than traditional suture (p < .001). CONCLUSION: Use of barbed suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty.

Robotic hiatal hernia repair without mesh.

Background: Newer minimally invasive techniques have supplanted laparotomy and thoracotomy for management of hiatal hernias. Limited data exists on outcomes after robotic hiatal hernia repair without mesh despite the increasing popularity of this approach. We report our high-volume experience with durable robotic hiatal hernia repair with gastric fundoplication without mesh. Methods: A retrospective review was conducted on patients with type I-IV hiatal hernias who underwent an elective robotic-assisted repair from 2016 to 2019 using a novel technique of approximating the hiatus with running barbed absorbable (V-locTM) suture and securing it with interrupted silk sutures. Main outcomes included length of stay, readmission rate, and recurrence rate. Results: A total of 144 patients were reviewed. The average age of the patient was 61 years. Most of the patients were female [95 females (66%) to 49 males], and the average body mass index (BMI) was 29.96 kg/m2. The average operating time was 173 minutes (standard deviation 62 minutes). The average length of stay in the hospital was 2 days, and 89% of patients went home within the first 3 days. Ten patients (6.9%) were readmitted within 30 days, there were no mortalities in 30 days, and there were 6 (4.2%) recurrences on follow up requiring reoperation. Conclusions: Elective robotic hiatal hernia repair with fundoplication and primary closure of the hiatus with V-locTM and nonabsorbable suture without mesh is safe and effective. The robotic approach has similar operative times, lengths of stay, and complications compared to nationally published data on laparoscopic hiatal hernia repairs.

Safety and Efficacy of Barbed Sutures Compared to Non-barbed Sutures in Bariatric Surgery: An Updated Systematic Review and Meta-analysis.

PURPOSE: Mastering intracorporeal suturing is challenging in the evolution from conventional to laparoscopic bariatric surgery. Among various techniques competing for superiority in overcoming this hurdle, we focus on exploring the potential of barbed sutures through a meta-analysis that compares outcomes to those of conventional non-barbed sutures in bariatric surgery. MATERIALS AND METHODS: We conducted a comprehensive search on PubMed, Scopus, and Embase to identify studies comparing barbed sutures with non-barbed sutures in bariatric surgeries, focusing on outcomes such as operative time, suturing time, postoperative complications, and hospital stay. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. RESULTS: Incorporating data from 11 studies involving a total of 27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries, our analysis demonstrates a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p < 0.01; I2 = 99%) associated with the use of barbed sutures. Specifically, in Roux-en-Y gastric bypass, we observed a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p < 0.01; I2 = 93%). Subgroup analyses and leave-one-out analyses consistently supported these findings. Furthermore, we found that the mean body mass index did not significantly predict the mean difference in operative time outcome. No significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction (p > 0.05). CONCLUSION: Our study findings address barbed sutures as a potential alternative for laparoscopic intracorporeal suturing in bariatric surgery.

Evaluation of total laparoscopic hysterectomy with and without the use of barbed suture.

OBJECTIVE: To evaluate the outcome of total laparoscopic hysterectomy with and without the use of barbed suture. METHODS: We conducted a retrospective study among patients who underwent total laparoscopic hysterectomy between February 2008 and August 2012. The parameters evaluated were age, BMI, operative time, hospital stay, pre- and postoperative hemoglobin levels, uterine weight, intraoperative blood loss, and postoperative complications. RESULTS: A total of 202 women underwent total laparoscopic hysterectomy; barbed suture (V-Loc) was used in 63 women, and polydioxanone (PDS) in 139. Estimated blood loss, difference in hemoglobin level before and after surgery, operative time, and the duration of hospital stay were comparable between the two groups of patients. The incidence of postoperative fever was higher in the V-Loc group than in the PDS group (P = 0.003). Multiple linear regression analysis showed that the incidence of postoperative fever was related to BMI (P = 0.02, r = 0.22) and estimated blood loss (P = 0.004, r = 0.28) and not to age, operative time, or uterine weight. CONCLUSION: The use of barbed suture to close the vaginal vault after laparoscopic hysterectomy, compared with standard suture, results in similar operative time, blood loss, and duration of hospital stay. The use of barbed suture is technically less demanding than the use of regular sutures.

Objectif : Évaluer l'issue de l'hystérectomie laparoscopique totale, avec ou sans utilisation de sutures barbelées. Méthodes : Nous avons mené une étude rétrospective auprès de patientes ayant subi une hystérectomie laparoscopique totale entre février 2008 et août 2012. Les paramètres évalués étaient l'âge, l'IMC, la durée opératoire, le séjour à l'hôpital, les taux d'hémoglobine préopératoire et postopératoire, le poids utérin, la perte sanguine peropératoire et les complications postopératoires. Résultats : Au total, 202 femmes ont subi une hystérectomie laparoscopique totale; une suture barbelée (V-Loc) a été utilisée chez 63 femmes, tandis qu'une suture polydioxanone (PDS) a été utilisée chez les 139 autres femmes. La perte sanguine estimée, la différence entre le taux d'hémoglobine constaté avant la chirurgie et celui qui est constaté après celle-ci, la durée opératoire et la durée du séjour à l'hôpital étaient comparables dans les deux groupes de patientes. L'incidence de la fièvre postopératoire était plus élevée au sein du groupe « V-Loc ¼ qu'au sein du groupe « PDS ¼ (P = 0,003). L'analyse de régression linéaire multiple a indiqué que l'incidence de la fièvre postopératoire était liée à l'IMC (P = 0,02, r = 0,22) et à la perte sanguine estimée (P = 0,004, r = 0,28), mais non à l'âge, à la durée opératoire ou au poids utérin. Conclusion : L'utilisation d'une suture barbelée pour fermer le dôme vaginal à la suite d'une hystérectomie laparoscopique donne lieu à des résultats semblables à ceux de l'utilisation d'une suture standard en ce qui concerne la durée opératoire, la perte sanguine et la durée du séjour à l'hôpital. L'utilisation d'une suture barbelée est moins exigeante sur le plan technique que l'utilisation de sutures régulières.

Barbed sutures in plastic surgery: a personal experience.

Secure closure of wounds is vital to any plastic surgery procedure. Recent developments in suture design have incorporated the creation of small barbs along the suture strand that are intended to engage the surrounding soft tissue and "lock" the suture (and, therefore, the wound closure) into place. Early experience with this type of modified suture has shown promise for a host of wound closure indications, including the closure of skin and fat as well as superficial and deep fascia. Advantages include secure wound closure, elimination of the need for a "third hand," decreased operative time, and an improved appearance in cutaneous scars.

Strangulated ileus from barbed suture following robot-assisted radical cystectomy: A case report.

The barbed suture e.g. V-Loc™, are occasionally used in urological surgery due to the practical advantage of omitting the need for surgical knots and reducing surgical time. In this report, an 83-year-old man diagnosed as having invasive bladder cancer underwent robot-assisted radical cystectomy: on the thirteenth postoperative day, he was diagnosed as having strangulated ileus of the small bowel. The small bowel was strangulated by bands formed between the stump of V-Loc™ and the fatty appendices of the sigmoid colon. This is the first report of a small bowel ileus associated with the barbed suture in the field of urology.

Unidirectional Barbed Suture Versus Polyglactin 910 Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy.

Introduction and objective Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-LocTM 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy. Methods  A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia. Results Demographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups. Conclusions The unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.

Asymmetric 6-Strand Flexor Tendon Repair - Biomechanical Analysis Using Barbed Suture.

Background: This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Methods: Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc® 3-0 and Supramid® 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. Results: All the repairs using V-Loc® 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc® sutures failed by suture breakage while 80% of repairs using Supramid® sutures failed by suture pullout. Conclusions: The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).

Robot-assisted bronchoplasty using continuous barbed sutures.

We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors.

Robotic Single-Site Sacrocolpopexy with Retroperitoneal Tunneling.

INTRODUCTION: This series of cases was an investigation of the safety and feasibility of robotic laparoendoscopic single-site surgery (R-LESS) as a method of performing sacrocolpopexy. CASE PRESENTATION: This is a retrospective series of 15 cases of R-LESS sacrocolpopexy with the V-Loc (Medtronic, Minneapolis, Minnesota, USA) suture and a retroperitoneal tunneling technique performed by a single surgeon, combined with a literature review. Patient demographic information and perioperative data were analyzed. The standard robotic sacrocolpopexy steps were followed, but the surgeon used a combined technique of V-Loc suture and retroperitoneal tunneling to simplify the procedure. No additional ports were necessary in any of the patients. MANAGEMENT AND OUTCOME: Using the pelvic organ prolapse quantification (POP-Q) scoring method, the mean preoperative C-point of the 15 patients was +1.16 compared to the mean immediate postoperative C-point, which was -5.5. The mean total sacrocolpopexy time was 74.7 (range, 50-99) minutes and mean mesh anchoring time was 22.60 ± 3.85 minutes. The mean sacral promontory fixation and tunneling and mesh position times were 11.87 ± 3.02 and 5.80 ± 2.14 minutes, respectively. All 15 cases were performed without perioperative or long-term complications. DISCUSSION: R-LESS in combination with the V-Loc suture and the retroperitoneal tunneling technique can be safely and feasibly performed, especially in sacrocolpopexy and, potentially, in other POP surgeries. With adequate and systematic training, surgeons can acquire the necessary skills to perform this complex surgical procedure.

Postoperative mechanical small bowel obstruction induced by V-Loc barbed absorbable suture after laparoscopic distal gastrectomy.

When performing laparoscopic gastrectomy, suturing the intestinal anastomosis presents one of the greatest challenges. The V-Loc unidirectional barbed suture has been introduced to eliminate the need to tie knots during closure. This device offers a fast, secure, and effective alternative to conventional suture repair during laparoscopic surgery. However, there have been reported cases of surgical complications associated with the use of barbed suture devices. We describe here a case of small bowel obstruction resulting from improper use of barbed suture during total laparoscopic distal gastrectomy performed for gastric cancer. Following diagnosis of small bowel obstruction, the patient underwent immediate laparoscopic repair that identified the cause and relieved the small bowel obstruction. This case highlights the need for surgeons to carefully perform proper suturing technique in order to prevent complications. Surgeons should maintain a high index of suspicion for diagnosing and treating potentially severe complications when using barbed sutures.

Technical Feasibility of Enterotomy Closure with Knotless Barbed Suture Material (V-Loc 180) in Esophagojejunostomy Using Linear Stapler during Totally Laparoscopic Total Gastrectomy for Gastric Cancer.

PURPOSE: Intra-corporeal esophagojejunostomy (EJ) using a linear stapler creates a stapler entry hole that requires secure closure during the totally laparoscopic total gastrectomy (TLTG) procedure for gastric cancer. Since a standard method has not been established yet, the feasibility of using V-loc 180 (Covidien, Mansfield, MA, USA) suture material was evaluated in this study. MATERIALS AND METHODS: During January 2012 to March 2015, 25 patients who underwent linear stapling EJ and V-loc 180 closure of remaining enterotomy were included in this study. Basic clinico-pathological characteristics, surgical outcomes, and short-term complications were analyzed. RESULTS: The mean patient age was 60.4 ± 8.5 years. Nineteen males and six females were included in this study. The mean body mass index was 25.3 ± 2.3 kg/m2. There were 22 stage-I, 2 stage-II, and 1 stage-III gastric cancer patients. The mean operation time was 240.5 ± 44.6 min, and the time for anastomosis was 38.8 ± 11.2 min. The procedures were successfully performed in all cases without any intra-operative complications. There was one case of EJ leakage that occurred at the corner of EJ staple line and not at the enterotomy closure site. CONCLUSIONS: The closure of the remaining enterotomy site using V-loc 180 suture following linear stapler EJ is technically feasible and safe during the TLTG procedure. However, further experience and results from other surgeons are necessary to generalize this procedure.