OBJECTIVES : To conduct a systematic literature review of studies assessing clinical outcomes associated with minimally invasive hysterectomies performed with barbed sutures versus those performed with conventional sutures.

METHODS : A systematic search of PubMed and Scopus was conducted for literature published between January 2011 and June 2020. The Boolean query (barb* OR knotless AND sutur* AND minimally AND invasive OR robot* OR laparoscopic AND hysterectomy) was employed. Additional articles were identified through manual reviews of references. Pre-clinical studies, case reports and conference abstracts were excluded from review.

RESULTS : Of the 105 studies identified, five met the predefined inclusion criteria. The risk for major vaginal bleeding for the barbed suture group was up to 50% lower than that for the conventional suture group (14% vs. 27%). There was no significant difference in minor vaginal bleeding incidence in the two studies that examined this outcome. Vaginal cuff dehiscence incidence was up to 7% lower in the barbed suture group compared to the conventional group (0% vs. 7%). The difference in median operative time ranged from 1 minute (extracorporeal suturing) to 19 minutes, with time saved for the barbed suture group in all studies. Median vaginal cuff suture time was also shorter for the barbed suture group by 2-6 minutes, according to three out of four studies.

CONCLUSIONS : The literature suggests that barbed sutures are a useful tool for vaginal cuff suturing in minimally invasive hysterectomies. While there was variation in statistical significance of the differences in the outcomes of interest, all studies demonstrated similar or moderately better outcomes and shorter operation time for the barbed suture group. More research is needed to generate a more conclusive evidence.