Laparoscopic myomectomy (LM) is one of the techniques feasible for the treatment of intramural myoma. This technique is reported to be difficult when large fibroids are involved because of excessive blood loss during surgery. Skillful and fast suturing appears to be associated with reduced blood loss during LM. Barbed sutures have been recently introduced to facilitate laparoscopic suturing. A suture with bidirectional barbs offers several advantages over conventional sutures. Although the efficacy and safety of barbed sutures have been demonstrated in various gynecologic surgeries in many countries, no comparable studies have been conducted in Japan. Therefore, in this study, we compared surgical outcomes of using bidirectional Stratafix barbed sutures versus conventional sutures during LM.
This retrospective study included all patients who underwent LM for the treatment of intramural myoma in our institution between 2015 and 2017. Patients were divided into two groups according to the technique of suturing during LM: group 1 comprised patients in whom Stratafix barbed suture was used (n = 29), and group 2 comprised those in whom conventional sutures was used (n = 10). Data of patient age, myoma size, hemoglobin levels, total operation time, and blood loss during surgery were compared between the two groups.
No significant differences in age (P = 0.443) or myoma size (P = 0.343) were observed between the two groups. Operation time (P = 0.0134) and blood loss (P = 0.0395) during surgery was significantly less with Stratafix barbed suture than with conventional suture. No patient required intraoperative transfusion or conversion to laparotomy.
The use of bidirectional barbed suture reduces operation time and blood loss. As these new sutures have barbs, no knot-tying is required; thus, continuous suturing becomes very simple, and maintaining hemostasis is easy. Inexperienced gynecological surgeons who apply this suture technique can also perform LM easily. As a bidirectional barbed suture has multiple points of fixation, this suture technique can reapproximate tissue securely, which reduces chances of reoperation because of proper suture knotting. Therefore, bidirectional Stratafix barbed sutures could be an optimal and efficient alternative to conventional sutures for use by gynecological surgeons in Japan.