Barbed Sutures in Minimally Invasive Gynecologic Surgery.

The introduction of knotless barbed suture into the surgical market has decreased the challenges of laparoscopic suturing. Since its introduction, barbed suture has gained popularity in the field of minimally invasive gynecologic surgery and is now commonly used to close the vaginal cuff in total laparoscopic hysterectomy, to re-approximate the myometrium after laparoscopic myomectomy, and to shorten the procedure time during a laparoscopic sacrocolpopexy. Barbed sutures facilitate rapid and consistent wound closure, allowing for equal distribution of tissue tension across the suture line, and thereby providing a more secure wound closure. The most commonly encountered complication after the use of barbed sutures is postoperative bowel obstruction. Proposed methods to decrease the likelihood of this complication include ensuring that the ends of the barbed suture are either buried, over-sewn, or cut flush with the tissue.