Comparing the impact of three‐dimensional display systems and barbed V‐LOC™ sutures in laparoscopic hysterectomy: A retrospective cohort study

Abstract Aim This study aims to evaluate the impact of two‐dimensional (2D) versus three‐dimensional (3D) imaging systems and barbed versus standard absorbable multifilament sutures on surgical times and complications in total laparoscopic hysterectomy. Methods A retrospective cohort study was conducted at a tertiary hospital between May 2020 and September 2024. Patients who underwent total laparoscopic hysterectomy were categorized into four groups based on imaging system (UltraHD‐2D vs. FullHD‐3D) and suture type (VICRYL™ multifilament suture interrupted figure‐of‐8 technique vs. V‐LOC™ barbed suture running technique). Primary outcomes included vaginal cuff closure time and total operation duration. Secondary outcomes were mean suturing time, perceived difficulty, and postoperative complications. Results A total of 159 patients were analyzed. Vaginal cuff closure time was significantly shorter with 3D imaging systems compared to 2D systems when VICRYL™ sutures were used (13.85 ± 4.30 vs. 21.17 ± 5.13 min, p < 0.001). No significant difference was observed between imaging systems when V‐LOC™ barbed sutures were used. Across both systems, V‐LOC™ sutures consistently reduced suturing time compared to VICRYL™ sutures ( p < 0.001). Surgeon‐perceived difficulty was lower with V‐LOC™ sutures, particularly in 2D systems. No significant difference in complication rates was observed between groups ( p = 0.188). Conclusion The use of 3D imaging systems in total laparoscopic hysterectomy significantly reduces vaginal cuff closure duration and overall operative time with VICRYL™ sutures, while V‐LOC™ sutures consistently enable faster procedures across both imaging modalities. These findings suggest that 3D imaging systems and barbed sutures may enhance surgical efficiency without increasing complication rates.