BEST: Barbed-suture Efficiency Study for Sacrocolpopexy: A Randomized Clinical Trial

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Robotic sacrocolpopexy is a surgical treatment for pelvic organ prolapse.
• Vaginal mesh attachment is a key step in this procedure.
• Suture selection may impact operative efficiency and surgeon experience.

Purpose of the Study:

• To compare the efficacy of absorbable unidirectional barbed suture versus nonbarbed suture for vaginal mesh attachment during robotic sacrocolpopexy.
• To assess the impact on suture time, surgeon satisfaction, and patient-centered outcomes.

Main Methods:

• A single-blind, randomized trial involving 52 women undergoing robotic sacrocolpopexy.
• Participants were randomized to either barbed or nonbarbed suture for mesh attachment.
• Surgeon-reported outcomes and 6-month patient-centered outcomes were evaluated.

Main Results:

• Vaginal mesh attachment time was significantly shorter with barbed suture (13.2 min) compared to nonbarbed suture (19.7 min).
• Barbed suture showed greater time savings for resident and fellow surgeons.
• Surgeons reported higher ease of use and satisfaction with barbed suture, with similar mesh appearance.

Conclusions:

• Absorbable unidirectional barbed suture offers a significant reduction in vaginal mesh attachment time during robotic sacrocolpopexy.
• The benefits were more pronounced in surgeons with less experience.
• Barbed suture use led to increased surgeon satisfaction without compromising patient-centered outcomes at six months.