优化阴道袖带闭合：对全腹腔镜和机器人辅助子宫切除术中倒刺缝合与传统缝合的系统回顾和荟萃分析。

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-07-09 DOI:10.1016/j.jmig.2025.06.023

Laura Vilar Planella MD , Ignacio Rodríguez García MSc , Silvia Franco Camps MD , Pere N. Barri-Soldevila MD , Silvia Cabrera Díaz MD, PhD

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引用次数: 0

摘要

目的：本荟萃分析旨在比较全腹腔镜和机器人辅助子宫切除术中，倒刺缝合（BS）和传统缝合（CS）对阴道袖带闭合的影响，评估其对手术时间、缝合时间、出血量、术后并发症、手术部位感染和肉芽组织形成的影响。数据来源：对电子数据库PubMed/MEDLINE和EMBASE进行全面检索，涵盖2004年至2024年6月发表的文献。研究选择方法：进行系统回顾和荟萃分析，包括24项研究，包括4,593名妇女（BS组2,212名，CS组2,381名）。数据分别对腹腔镜和机器人辅助手术进行分析。表列、综合和结果：两种手术入路BS和CS的阴道袖带破裂（VCD）率无显著差异。在腹腔镜子宫切除术中，BS显著减少手术时间8.58分钟(95% CI -14.05；-3.10)，缝合时间缩短4.9分钟(95% CI -7.16；-2.65)，估计失血量减少5.42 mL (95% CI -10.71；-0.12)。在机器人辅助子宫切除术中，BS显著缩短了手术时间(-37.82分钟，95% CI -54.88；-20.76)和肉芽组织形成(2.61%对11.29%，BS有利，95% CI 0.18；1、23)。两种入路在术后并发症和手术部位感染方面均无显著差异。结论：BS是微创子宫切除术中阴道袖带闭合安全有效的选择。它们在腹腔镜手术中具有显著的优势，减少了手术时间、缝合时间和出血量，而在机器人辅助手术中，它们缩短了手术时间并减少了肉芽组织的形成。这些发现支持BS作为优化手术结果的可靠选择。

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Optimizing Vaginal Cuff Closure: A Systematic Review and Meta-Analysis of Barbed Versus Conventional Sutures in Total Laparoscopic and Robot-Assisted Hysterectomies

Objective

This meta-analysis aimed to compare barbed sutures (BS) and conventional sutures (CS) for vaginal cuff closure in total laparoscopic and robot-assisted hysterectomies, evaluating their impact on operative time, suture time, blood loss, postoperative complications, surgical site infections, and granulation tissue formation.

Data Sources

A comprehensive search of the electronic databases PubMed/MEDLINE and Embase was conducted, covering literature published from 2004 to June 2024.

Methods of Study Selection

A systematic review and meta-analysis were conducted, including 24 studies comprising 4.593 women (2212 in the BS group and 2.381 in the CS group). Data were analyzed separately for laparoscopic and robot-assisted procedures.

Tabulation, Integration, and Results

No significant differences were found in vaginal cuff dehiscence rates between BS and CS in both surgical approaches. In laparoscopic hysterectomies, BS significantly reduced operative time by 8.58 minutes (95% confidence interval [CI], −14.05 to −3.10), suture time by 4.9 minutes (95% CI, −7.16 to −2.65), and estimated blood loss by 5.42 mL (95% CI, −10.71 to −0.12). In robot-assisted hysterectomies, BS significantly reduced operative time (−37.82 minutes; 95% CI, −54.88 to −20.76) and granulation tissue formation (2.61% vs 11.29%, favoring BS; 95% CI, 0.18–1.23). No significant differences were observed in postoperative complications or surgical site infections for either approach.

Conclusion

BS are a safe and effective option for vaginal cuff closure in minimally invasive hysterectomies. They offer significant advantages in laparoscopic procedures by reducing operative time, suture time, and blood loss, whereas in robot-assisted surgeries, they shorten operative time and decrease granulation tissue formation. These findings support the use of BS as a reliable choice for optimizing surgical outcomes.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.