Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

Abstract

Purpose: One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc^™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries.

Methods: We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187.

Results: In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation.

Conclusion: This meta-analysis indicates that V-Loc^™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.

Keywords: Barbed suture; Hysterectomy; Meta-analysis; Myomectomy; V-Loc.

Fig. 1

Study selection for this systematic review and meta-analysis outlined in a PRISMA flowchart

Fig. 2

Pooled estimates of operation time [min] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , –, , , –

Fig. 3

Pooled estimates of suture time [min] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , , –, , , , ,

Fig. 4

Pooled estimates of total post-operative complications and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: –, , , , –

Fig. 5

Pooled estimates of surgical site infections and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , , ,

Fig. 6

Pooled estimates of estimated blood loss [ml] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , –, , , , , –

Fig. 7

Pooled estimates of length of hospital stay [days] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , , , –, –

Fig. 8

Pooled estimates of formation of granulation tissue and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , , , ,

Fig. 9

Pooled estimates of surgical difficulty [VAS score] and subgroup analysis according to surgery type for the use of VBS versus CS in OB/GYN surgery. Data extracted from references: , , ,

Fig. 10

Effect of sensitivity analyses on pooled estimates of outcomes. Presented are the changes in pooled outcome estimates in percent if a) all studies rated “poor” were excluded from the analysis, b) the top 10% (n = 3) studies with the largest patient population were excluded from the analysis, and c) studies reporting outlier values for each outcome were excluded from the analysis