Use of cyanoacrylate glue for the closure of uterine incisions.

Closure of uterine incisions in a variety of gynecological procedures, specifically in myomectomy operations, is associated with significant hemorrhage. Excessive suturing to control bleeding may have negative effects on wound healing and might increase peritoneal adhesions. Moreover, difficulty of handling uterine tissue in laparoscopic procedures is not only a factor for suboptimal closure and inadequate control of bleeding but also a significant factor for surgeons for choosing laparotomy over laparoscopic approach. Cyanoacrylates are a group of molecules used as industrial adhesives. Newer cyanoacrylates are widely used in medicine. These agents are excellent biological adhesives due to strong adhesive action, hemostatic action, and antibacterial properties. Moreover, the presence of blood and tissue fluids enhances the activity of cyanoacrylates. In this study, 2-octyl cyanoacrylate, polypropylene, and polyglactin 910 sutures were compared in terms of adhesive strength, control of hemorrhage and postoperative intraabdominal adhesions in a rat model. Wound healing was excellent in all groups. Cyanoacrylates were associated with significantly lower total adhesion scores. This is the first report proposing the use of cyanoacrylates in gynecologic surgeries with supporting evidence for clinical use. Cyanoacrylates might be the first choice for the closure of uterine incisions and for the control of hemorrhage especially in laparoscopic procedures.