BARBED vs. STANDARD Suture for Colporrhaphy at the End of Laparoscopic Hysterectomy
- Conditions
- Vaginal Cuff Complications
- Interventions
- Procedure: Laparoscopic colporrhaphy with 0-caliber barbed absorbable sutureProcedure: Laparoscopic colporrhaphy with standard 0-caliber absorbable suture
- Registration Number
- NCT05833204
- Lead Sponsor
- Universita di Verona
- Brief Summary
Hysterectomy is one of the most common surgical procedures performed worldwide, with more than 400,000 hysterectomies performed annually in the United States. As a consequence, even uncommon complications can affect large numbers of patients. Among potentially life-threatening events, vaginal cuff dehiscence complicates 0.14-1.38% of procedures, and any vaginal cuff complications (dehiscence, hematoma, bleeding, infection) are estimated to affect 4.7-9.8% of patients. In this scenario, any preventive strategy can provide clinically relevant benefits. Regarding colporrhaphy, only the adoption of a laparoscopic approach instead of a vaginal approach is supported by high-quality evidence. Our group demonstrated that the laparoscopic closure of the vaginal cuff after total laparoscopic hysterectomy reduces the incidence of vaginal cuff complications.
Among other potentially effective interventions, the use of barbed sutures was associated with a lower incidence of vaginal cuff dehiscence than the standard suture. In a recent meta-analysis, the use of barbed sutures has been associated with a pooled incidence of vaginal cuff dehiscence of 0.4% versus 2% after a traditional vaginal suture. However, this evidence is limited because most pooled studies were retrospective, and only two were randomized controlled trials. Moreover, these two randomized controlled trials had a very small sample size and were not powered to detect clinically relevant differences. On that basis, despite the promising utility of barbed sutures for vaginal cuff closure after total laparoscopic hysterectomy, the choice of the type of suture is not evidence-based but still guided by personal opinions, as well as by the preference and habits of the operators.
Therefore, this study aims to investigate whether the laparoscopic vaginal cuff closure with barbed suture determines a lower incidence of vaginal cuff dehiscence and complications than conventional sutures after total laparoscopic hysterectomy.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- Female
- Target Recruitment
- 1614
- Patients undergoing elective total laparoscopic hysterectomy
- Surgery performed for the treatment of benign pathology
- Age > 18 years
- Surgery performed by laparoscopy
- Signature of informed consent
- Patients undergoing emergent surgery
- Patients candidates for hysterectomy for oncological indication
- Patients who underwent previous radiation therapy
- Patients allergic to the suture material used in the study
- Patients unable to express adequate informed consent to participate in the study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Colporrhaphy with barbed absorbable suture Laparoscopic colporrhaphy with 0-caliber barbed absorbable suture The colporrhaphy will be performed using a 0-caliber barbed absorbable suture (V-Loc â„¢, Covidien, Medtronic) Colporrhaphy with standard absorbable suture Laparoscopic colporrhaphy with standard 0-caliber absorbable suture The colporrhaphy will be performed using a standard 0-caliber absorbable suture made of a coated braided thread (Vicryl; Ethicon Inc, Sommerville, NJ)
- Primary Outcome Measures
Name Time Method Vaginal cuff dehiscence 90 days after surgery Any partial or total separation of the vaginal cuff
- Secondary Outcome Measures
Name Time Method Vaginal cuff complications 90 days after surgery Hematoma, abscess, infections, bleeding, resuture of the vaginal cuff
Intraoperative blood loss During surgery Total blood aspirate during the surgical procedure
30-day post-surgical morbidity 30 days after surgery Perioperative (intraoperative and postoperative) complications graded based on the Clavien-Dindo classification
Hospital stay From the date of hospital admission to the date of hospital discharge. Days of hospitalization from the day of admission to the day of discharge.
Operative time During surgery Time between first incision and skin closure
Quality of life index 90 days after surgery The Short Form 12 Health Survey (SF-12) investigates 8 different health aspects. Physical activity, role and physical health, role and emotional state, and mental health are measured by two questions. The SF-12 scores range from 0 to 100, with higher scores indicating better physical and mental health functioning.
Sexual function 90 days after surgery The female sexual function index (FSFI) consists of 19 multiple-choice items that assess female sexual functioning based on 6 domains: desire, arousal, orgasm, pain, sexual satisfaction, and lubrication. The total score ranges from 0 to 36, with 26.55 as the cut-off suggesting the presence of sexual dysfunction. The higher the score, the better the sexual function.
Trial Locations
- Locations (1)
AOUI Verona - University of Verona - Department of Obstetrics and Gynecology
🇮🇹Verona, Italy