Unidirectional barbed versus single layer conventional suture for vaginal cuff closure in robotic hysterectomy: retrospective single-center study

Objective: Successful vaginal cuff suturing remains a major challenge in robotic hysterectomy. This study compared the vault closure time by using Vicryl (polyglactin 910) and barbed (V-Loc) sutures. Material and Methods: This retrospective study included patients undergoing robotic hysterectomy for benign disease over three years. Patients were grouped according to the suture used for vaginal vault closure. Surgical videos and hospital records were reviewed to obtain operative details, perioperative outcomes, and postoperative complications. Results: A total of 297 patients were included in final analysis with 106 (35.7%) patients in the Vicryl group and 191 (64.3%) patients in the barbed suture group. In the barbed compared to Vicryl group, the robotic vault closure time (6.84±1.42 vs. 9.93±2.77 minutes), average number of stitches used for vault closure (5.02±0.57 vs. 5.61±0.75), and time taken per stitch (1.36±0.3 vs. 1.75±0.43 minutes) were significantly lower. Operative time, anesthesia duration, and hospital stay were also significantly lower in the barbed group. On multivariable linear regression analysis, barbed suture use remained independently associated with shorter vault closure time (β =8.47 minutes, 95% confidence interval 5.46-11.48; p<0.001), while age, body weight, body mass index, parity, and preoperative anemia were not independently associated with vault closure time. On sexual function assessment, the overall score of female sexual function index in barbed (29.02±4.85) was significantly higher than the Vicryl (27.39±7.35) suture group (p=0.049). Conclusion: Barbed sutures may represent a feasible and time-efficient option for robotic vaginal vault closure; however, prospective randomized studies with longer follow-up are required to confirm their safety, and impact on functional outcomes.