The Use of Barbed Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy

The Hysterectomy procedure is the most frequently performed gynecological surgery in the world [1]. This procedure can be carried out using an abdominal, vaginal, and laparoscopic approach. The percentage of hysterectomies performed via laparoscopy varies. For instance, 12% of the hysterectomies performed in the USA are performed laparoscopically [2], while 15% of the hysterectomies in the UK are performed via laparoscopy [3]. In our center, at the Castellon General University Hospital, the percentage of laparoscopic hysterectomies is 34%. In the scientific literature, the rate of complications of vaginal cuff closure post laparoscopic hysterectomy ranges from 0 to 5% [4,5], the most common complications being: vaginal bleeding, dehiscence of the vaginal cuff and infection. Numerous strategies were undertaken in order to decrease such complications [6,7]. One solution has been the introduction of the unidirectional barbed suture for vaginal cuff closure. The latter has demonstrated a lower technical difficulty [8-10] as well as a decrease in the surgical time, intraoperative complications and a lower incidence of suture dehiscence [9,11]. The use of the barbed suture has been described in multiple gynecological procedures, such as the hysterectomy, myomectomy and colposacropexy [1214]. The favorable results obtained in several studies suggest that the suture material has the potential to become an asset in gynecological surgery. The aim of this work is to evaluate the safety and efficacy of the barbed unidirectional suture in a total laparoscopic hysterectomy. Materials and Methods