COMPARISION OF POLYGALACTIN 910 WITH BARBED SUTURES FOR VAGINAL CUFF CLOSURE IN TOTAL LAPROSCOPIC HYSTERECTOMY

Hysterectomy is one of the very commonly performed gynecological procedures. In the recent times a shift is seen in preference of laparoscopic hysterectomies over laparotomy. Laparoscopy has several important advantages over laparotomy, which include less pain, reduced recovery time, shorter hospital stay, and avoidance of a large operative scar[1]. Laparoscopic hysterectomy has been reported to have higher rates of vaginal complications including vaginal cuff dehiscence compared to open surgery. Laparoscopic colpotomies using electrosurgical devices likely cause more tissue necrosis and devascularization owing to higher vaginal complications. Laparoscopic hysterectomy is also associated technical difficulty and long learning curve, that might add to the complications rate. Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. In TLH, the vaginal cuff can be sutured laparoscopically (either intracorporeal or extracorporeal) and vaginally[2].  Endoscopic suturing with knotting increases the time of surgery considerably[3].

The barbed suture is a relatively newer suture material. It is being used for closure in laparoscopic surgeries. The haemostatic properties and ease of use has made barbed sutures (Trubarb) a preferred mode of closure. Currently polyglactin 910 (Trusynth) is widely used for closure of vaginal cuff, by continuous interlocking suturing and knotting for the closure of vaginal cuff in total laparoscopic hysterectomies.