Skip to main content
Search
Search
Advanced Search
Skip main navigation
Open access
Short Report
17 March 2025

Trends in adoption of knotless tissue control devices in robotic surgery

Authors: Barbara H Johnson https://orcid.org/0000-0001-7973-8902 [email protected], Sinchana T, Stephen S Johnston, and Najmuddin GunjaAuthor Info & Affiliations
Volume 14, Number 4
https://doi.org/10.57264/cer-2024-0229
PDFFormats

Abstract

Aim: Trends in the use and comparative outcomes for barbed and conventional sutures have not been well-reported for robotic surgery. Materials & methods: This retrospective study used hospital discharge data in the US to assess suture use during robotic colorectal surgery (CR), total hysterectomy (TH) and ventral hernia repair (VHR) performed between 1 October 2015 and 30 June 2022. We first examined quarterly trends in use of barbed sutures, (specifically STRATAFIX™ knotless tissue control devices [KTCD]) and then compared clinical and economic outcomes between KTCD and conventional sutures. Outcomes included wound-related complications (infection/wound dehiscence) through 90 days post discharge, operating room (OR) time, hospital costs and 30/60/90 days readmissions. Propensity score weighting was used to address potential confounding in the comparisons of outcomes, performed separately for each procedure. Generalized linear models, accounting for hospital-level clustering, with link functions and error distributions tailored to the empirical distribution of outcomes were used to test for statistically significant differences in outcomes between the KTCD and conventional suture cohorts. Results: We identified 15,875 patients with CR (668 KTCD), 175,963 patients with TH (15,075 KTCD) and 32,469 patients with VHR (6776 KTCD). Over the study period, the proportion of robotic surgeries using KTCD tripled for CR (2.0–6.4%) and TH (2.9–10.4%) and more than doubled for VHR (12.2–25.3%). Compared with conventional sutures, KTCD was associated with significantly shorter OR time for TH (-19.1 min, 95% CI: [-30.2, -8.0]) and VHR (-17.3 min, 95% CI: [-31.4, -3.2]), and was numerically shorter, but did not reach statistical significance for CR (-23.2 min 95% CI: [-48.1 to 1.7]). All other outcomes were similar between the two suture cohorts for all procedures, apart from CR 90-day readmissions, which were lower for the KTCD cohort (-2.8%, 95% CI: [-5.2 to -0.4%]). Conclusion: Adoption of KTCD has grown substantially over the past 6 years. While most clinical and economic outcomes were similar between the two groups, KTCD was associated with lower OR time versus conventional sutures for TH and VHR and lower 90-day readmissions for CR.

Plain language summary

What is this article about?

The use of robotic assistance for surgical procedures has increased dramatically over the last two decades. Concurrent development and innovation of knotless tissue control devices (KTCD; also known as barbed sutures) has taken place and an uptake in the use of such sutures has been observed in robotically assisted procedures.
Researchers have compared various outcomes for barbed and conventional sutures in surgeries where a laparoscopic approach was used, however, to our knowledge, this type of comparative research has not been well-reported for robotic surgeries.
This study uses real-world data to address this important evidence gap from two perspectives. The first perspective examines the temporal trends in the use of KTCD during robotic ventral hernia repair (VHR), total hysterectomy (TH) and colorectal surgery in the US The second perspective compares selected outcomes in these robotic surgeries in which KTCD were used for wound closure as compared with conventional sutures.

What were the results?

KTCD use in robotic VHR, TH and colorectal surgery has grown substantially over the past 6 years. In addition, KTCD was associated with lower operating room time versus conventional sutures for VHR and TH.

What do the results mean?

In addition to the potential cost-savings associated with reductions in the operating room time needed for VHR and TH, these efficiency gains associated with KTCD may increase hospitals’ and surgical centers’ opportunity to serve more patients in any given day.

Shareable abstract

This study documents increasing use of knotless tissue control devices (barbed sutures) in common robotic procedures over time and procedure-specific benefits including shorter operating room times for both total hysterectomies and ventral hernia repairs without additional costs.

Supplementary Material

File (supplementary figure 1a.docx)
File (supplementary figure 1b.docx)
File (supplementary figure 1c.docx)
File (supplementary table 1.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Jeong IG, Khandwala YS, Kim JH et al. Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. J. Am. Med. Assoc. 318(16), 1561–1568 (2017).
Google Scholar
2.
Mederos MA, Jacob RL, Ward R et al. Trends in robot-assisted procedures for general surgery in the Veterans Health Administration. J. Surg. Res. 279, 788–795 (2022).
PubMed
Google Scholar
• This retrospective cohort study illustrates the increasing trend of robotic assistance in common surgical procedures among patients in the Veterans Health Administration.
3.
Bankar GR, Keoliya A. Robot-assisted surgery in gynecology. Cureus 14(9), e29190 (2022).
PubMed
Google Scholar
4.
Ravendran K, Abiola E, Balagumar K et al. A review of robotic surgery in colorectal surgery. Cureus 15(4), e37337 (2023).
PubMed
Google Scholar
5.
Kaan HL, Ho KY. Endoscopic robotic suturing: the way forward. Saudi J. Gastroenterol. 25(5), 272–276 (2019).
PubMed
Google Scholar
6.
Gowri KN, King MW. A review of barbed sutures—evolution, applications and clinical significance. Bioengineering (Basel) 10(4), 419 (2023).
PubMed
Google Scholar
•• Discusses how barbed sutures evolved from their start in the 1960’s to their increasing role in surgical procedures today.
7.
Greenberg JA, Goldman RH. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Rev. Obstet. Gynecol. 6(3–4), 107–115 (2013).
PubMed
Google Scholar
8.
Stone IK, von Fraunhofer JA, Masterson BJ. The biomechanical effects of tight suture closure upon fascia. Surg. Gynecol. Obstet. 163(5), 448–452 (1986).
PubMed
Google Scholar
9.
Lee S, Kee T, Jung MY, Yoon PW. A comparison of barbed continuous suture versus conventional interrupted suture for fascial closure in total hip arthroplasty. Sci. Rep. 12, 3942 (2022).
PubMed
Google Scholar
• Comparison between barbed and conventional sutures.
10.
Wang W, Yan S, Liu F et al. A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: a multicenter, randomized controlled trial. J. Orthop. Surg. (Hong Kong) 28(3), 2309499020965681 (2020).
Google Scholar
11.
Johnston SS, Chen BPH, Tommaselli GA, Jain S, Pracyk JB. Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison. J. Wound Care 29(Suppl. 5A), S9–S20 (2020).
PubMed
Google Scholar
• Comparison between barbed and conventional sutures.
12.
Lin Y, Long Y, Lai S et al. The effectiveness and safety of barbed sutures in the bariatric surgery: a systematic review and meta-analysis. Obes. Surg. 29(6), 1756–1764 (2019).
PubMed
Google Scholar
13.
Peleg D, Ahmad RS, Warsof SL, Marcus-Braun N, Sciaky-Tamir Y, Ben Shachar I. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. Am. J. Obstet. Gynecol. 218(3), 343.e1–343.e7 (2018).
PubMed
Google Scholar
• Comparison between barbed and conventional sutures.
14.
Karacan T, Ozyurek E, Usta T et al. Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. J. Obstet. Gynaecol. 38(6), 842–847 (2018).
PubMed
Google Scholar
• Comparison between barbed and conventional sutures.
15.
Zhou Y, Guthrie G, Chuang A, Faro JP, Ali V. Unidirectional barbed suture versus interrupted vicryl suture in vaginal cuff healing during robotic-assisted laparoscopic hysterectomy. J. Robotic Surg. 8(3), 201–205 (2014).
PubMed
Google Scholar
•• Comparison between barbed and conventional sutures in robotic-assisted surgery.
16.
Lin YF, Lai SK, Liu QY et al. Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: a systematic review and meta-analysis. Kaohsiung J. Med. Sci. 33(3), 107–115 (2017).
PubMed
Google Scholar
17.
Sundaram K, Piuzzi NS, Klika AK et al. Barbed sutures reduce arthrotomy closure duration and suture utilisation compared to interrupted conventional sutures for primary total hip arthroplasty: a randomised controlled trial. Hip Int. 31(5), 582–588 (2021).
PubMed
Google Scholar
18.
Manigrasso M, Velotti N, Calculli F et al. Barbed suture and gastrointestinal surgery. A retrospective analysis. Open Med. (War) 14, 503–508 (2019).
PubMed
Google Scholar
19.
Paul MD. Bidirectional barbed sutures for wound closure: evolution and applications. J. Am. Col. Certif. Wound Spec. 1(2), 51–57 (2009).
PubMed
Google Scholar
20.
Giampaolino P, De Rosa N, Tommaselli GA et al. Comparison of bidirectional barbed suture Stratafix and conventional suture with intracorporeal knots in laparoscopic myomectomy by office transvaginal hydrolaparoscopic follow-up: a preliminary report. Eur. J. Obstet. Gynecol. Reprod. Biol. 195, 146–150 (2015).
PubMed
Google Scholar
21.
Greenberg JA, Einarsson JI. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J. Minim. Invasive Gynecol. 15(5), 621–623 (2008).
PubMed
Google Scholar
22.
Round KJ, Yost CC, Rosen JL et al. Feasibility of robotic mitral valve repair using barbed nonabsorbable sutures: a preliminary single-center experience. Innovations 18(3), 254–261 (2023).
PubMed
Google Scholar
23.
PINC AI™ Applied Sciences, Premier Inc. PINC AI™ Healthcare Database: data that informs and performs (White Paper). (2023). Available at: https://offers.premierinc.com/rs/381-NBB-525/images/Premier-Healthcare-DatabaseWhitepaper-Final.pdf
Google Scholar
24.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav. Res. 46(3), 399–424 (2011).
PubMed
Google Scholar
25.
Nawrocki JG, Nonnenmann H, Mooney M, Sutton N, Schmitz ND. A high-strength, absorbable, antibacterial knotless tissue control device for fascial closure. Curr. Obstet. Gynecol. Rep. 6(2), 175–181 (2017).
PubMed
Google Scholar
26.
Sutton N, Schmitz ND, Johnston SS. Comparing outcomes between barbed and conventional sutures in patients undergoing knee or hip arthroplasty. J. Comp. Eff. Res. 7(10), 975–987 (2018).
PubMed
Google Scholar
• Comparison between barbed and conventional sutures.
27.
Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg. 153(4), e176233 (2018).
PubMed
Google Scholar
28.
Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: providing a practical framework for surgeons. Int. J. Health Plann. Manage 37(4), 1926–1940 (2022).
PubMed
Google Scholar
|