Optimizing Vaginal Cuff Closure: A Systematic Review and Meta-Analysis of Barbed Versus Conventional Sutures in Total Laparoscopic and Robot-Assisted Hysterectomies.

OBJECTIVE

This meta-analysis aimed to compare barbed sutures (BS) and conventional sutures (CS) for vaginal cuff closure in total laparoscopic and robot-assisted hysterectomies, evaluating their impact on operative time, suture time, blood loss, postoperative complications, surgical site infections, and granulation tissue formation.

DATA SOURCES: A comprehensive search of the electronic databases PubMed/MEDLINE and Embase was conducted, covering literature published from 2004 to June 2024.

METHODS OF STUDY SELECTION: A systematic review and meta-analysis were conducted, including 24 studies comprising 4.593 women (2212 in the BS group and 2.381 in the CS group). Data were analyzed separately for laparoscopic and robot-assisted procedures.

TABULATION, INTEGRATION, AND

RESULTS

No significant differences were found in vaginal cuff dehiscence rates between BS and CS in both surgical approaches. In laparoscopic hysterectomies, BS significantly reduced operative time by 8.58 minutes (95% confidence interval [CI], -14.05 to -3.10), suture time by 4.9 minutes (95% CI, -7.16 to -2.65), and estimated blood loss by 5.42 mL (95% CI, -10.71 to -0.12). In robot-assisted hysterectomies, BS significantly reduced operative time (-37.82 minutes; 95% CI, -54.88 to -20.76) and granulation tissue formation (2.61% vs 11.29%, favoring BS; 95% CI, 0.18-1.23). No significant differences were observed in postoperative complications or surgical site infections for either approach.

CONCLUSION

BS are a safe and effective option for vaginal cuff closure in minimally invasive hysterectomies. They offer significant advantages in laparoscopic procedures by reducing operative time, suture time, and blood loss, whereas in robot-assisted surgeries, they shorten operative time and decrease granulation tissue formation. These findings support the use of BS as a reliable choice for optimizing surgical outcomes.