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RCOG World Congress 2023

June 12 - 14, 2023 | London, UK

PP.0111

Laparoscopic suture techniques for cuff closure: a randomized controlled study

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Poster Presenter

Iliana Calabretti

Authors

Iliana Calabretti, Laura Gubser, Christiane Förster, Andreas Schötzau, Bernhard Fellmann-Fischer, Viola Heinzelmann-Schwarz, Tibor Zwimpfer

Affiliations

Medical Faculty, University of Basel, Department of Obstetrics and Gynaecology, University Hospital Basel, Department of Gynaecological Oncology, University Hospital Basel

Part of Topic

Medical Education

Comparison of different suture techniques for laparoscopic vaginal cuff closure in an ex-vivo model: a randomized controlled study

Introduction

Laparoscopic hysterectomy is a commonly performed procedure. However, one high-risk complication is vaginal cuff dehiscence, which is increased in laparoscopic approaches compared to abdominal or vaginal hysterectomies.Currently, there is no standardization regarding thread material and suturing technique for vaginal cuff closure. Furthermore, laparoscopic suturing is a challenging task that requires constant practice for correct and efficient execution. Therefore, this study aimed to compare extracorporeal and intracorporeal suturing techniques for vaginal cuff closure using a pelvic trainer model.

Methods

Eighteen experts in laparoscopic surgery performed vaginal cuff closures with interrupted sutures using intracorporeal knotting (Vicryl 2-0), extracorporeal knotting (Vicryl 2-0), and continuous, unidirectional barbed sutures (V-Loc™ 180 3-0) (Figure 1). While using an artificial tissue suturing pad in a Pelvitrainer (Figure 2), experts performed vaginal cuff closure using each technique according to block randomization. Task completion time, tension resistance (Figure 3), stitch precision, knot strength and the number of errors were recorded. After completing the exercises, participants answered a questionnaire concerning the suturing techniques and their performance.

Results

•Barbed suturing technique showed improved tension resistance compared to intracorporeal and extracorporeal knotting (p=0.002, p=0.003) (Figure 4B, Table 1)

•Barbed suturing technique allowed to complete the cuff closure significantly faster compared to intracorporeal and extracorporeal knotting (p < 0.001 , p < 0.001) (Figure 4A, Table 1)

•Intracorporeal knotting technique was performed faster (p=0.04) and achieved greater tension resistance (p=0.023) compared to extracorporeal knotting (Figure 4A/B, Table 1).

•There was no significant difference in precision between the three suturing techniques (Table 1).

•Experts who performed more laparoscopic surgeries per year were significantly faster in completing the tasks (p=0.007).

•Surgeon’s years of experience did not correlate with suturing time (p=0.293).

Conclusion

•Vaginal cuff closure with continuous barbed suturing was significantly faster and had improved tension resistance.

Barbed suturing was a time-saving technique in this ex-vivo study and should be recommended for use in clinical practice when available