Barbed sutures have been approved for use in Australia since 2008 with the introduction of the Quill suture by Surgical Specialties Corporation, followed by the V-Loc suture in 2011 by Coviden, and most recently the Stratafix by Ethicon in 2014.  The suture is designed with either uni- or bi-directional barbs circumferentially along the suture, with a suture needle at one end and a loop at the other. They come in a range of weights and absorption profiles. As a result of eliminating the need for technically difficult and time consuming laparoscopic knot tying, they have gained popularity for the closure of the vaginal vault at total laparoscopic & robotic hysterectomy. There has been scrutiny about its use in gynaecological surgery, and some concern regarding the risk of wound dehiscence, post operative sexual dysfunction and bowel injury. As such, to evaluate the validity of these concerns, we have reviewed the literature regarding the use of barbed sutures in closure of the vaginal vault at minimally invasive hysterectomy.

We identified nine studies regarding the use of barbed sutures in closure of the vaginal vault at robotic of laparoscopic hysterectomy. At the time of review, there was one case report of bowel injury related to closure of the vaginal vault with a barbed suture. All reviewed studies showed barbed sutures to have similar or reduced operating time, and have no statistical difference in vaginal cuff dehiscence, intra or post operative bleeding or post operative sexual dysfunction. There have been one case reports of bowel injury secondary to its use for closure of the vaginal vault but this was not seen in several large studies of using barbed sutures. Although serious, this is likely to be a rare complication of using barbed sutures, and is possibly related to length of the tail on the suture. Larger studies would be required to find it’s incidence.