Vaginal Cuff Closure in Robotic Hysterectomy: A Randomized Controlled Trial Comparing Barbed Versus Standard Suture

Objective: The aim of this research was to determine if there is a measurable time and/or cost savings with use of the V-Loc™ (Medtronic, Minneapolis, MN) barbed suture, compared to the VICRYL® (Ethicon, Somerville, NJ) suture for vaginal cuff closure. Design: This was a randomized controlled trial. Materials and Methods: Women undergoing robotic hysterectomy were randomized into 2 groups: 1 group received VICRYL suture closure of the vaginal cuff (n = 34) and the other group received V-Loc (n = 33) closure. Patients were blinded to their closure types. The primary outcome was vaginal cuff closure time. Secondary outcomes were operative costs, granulation tissue formation, vaginal cuff dehiscence, and dyspareunia for either partner postoperatively. Operative costs were analyzed at $22/minute, $62/minute, and $133/minute, including anesthesia, staff, operating room (OR), and equipment costs. Results: Vaginal cuff closure time was significantly less with the V-Loc suture (3.2 ± 1.1 minutes), compared to the VICRYL suture (7.6 + 2.7 minutes), p < 0.001. There were no differences in postoperative dyspareunia, vaginal cuff dehiscence, and granulation tissue formation at 3 months postoperatively. OR cost was significantly less at all cost intervals (p < 0.001). Conclusions: Using the V-Loc suture significantly reduced both time and operative costs associated with vaginal cuff closure, compared to the VICRYL suture. Larger studies are necessary to determine if postoperative complications of vaginal cuff closure are more frequent using the V-Loc suture, compared to the VICRYL suture. (J GYNECOL SURG 32:215)