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Einarsson, J. I.; Greenberg, J. A.
Ob/Gyn, Brigham and Women's Hospital, Boston, MA
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
The purpose of this video is to demonstrate our novel technique for hysterotomy closure using bidirectional barbed sutures. We will briefly demonstrate our original technique and then show the efficient use of this material to close a hysterotomy defect without the need to tie knots.
Bidirectional barbed sutures are created by cutting barbs into the suture with the barbs facing in an opposite direction to the needle. The barbs change direction at the midpoint of the suture. The anchoring of bidirectional barbed suture resists migration and can be conceptualized as a “continuous interrupted” suture without knots. We have used bidirectional barbed suture since March of 2008 and have performed over 100 hysterotomy closures with this material. In our experience, barbed suture greatly facilitates suturing by preventing backwards sliding of the suture, thereby enabling continuous suturing without the need for suture locking or to have another surgeon follow the suture. The initial version had a 6 cm “smooth” or non-barbed segment next to the needle. This resulted in sliding of the suture if the repair extended beyond the barbed segment of suture. To counteract this, we utilized LapraTy clips to secure the smooth segment of suture. The use of LapraTy in this manner was off-label, as LapraTy is indicated for use with 2/0, 3/0 and 4/0 Vicryl only. Despite this, we did not have any complications utilizing the LapraTy clips in this setting. With the advent of a second generation of Quill suture where the barbs extend all the way to the needle, the use of the LapraTy clip is not required.
The use of barbed suture greatly facilitates hysterotomy closure at the time of a laparoscopic myomectomy. We believe that the further integration of barbed suture into the armamentarium of the gynecologic surgeon is inevitable.
Barbed; Suture; Laparoscopic; Myomectomy
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