Role of Barbed Sutures in Gynaecological Laparoscopic Surgery - Evidence and Implementation

Abstract

Barbed sutures have emerged as a significant advancement in gynecological laparoscopic surgery, offering a knotless and efficient alternative to conventional suturing techniques. Their unique self-anchoring mechanism ensures continuous tension distribution, eliminates the need for intracorporeal knots, and simplifies suturing in confined pelvic spaces. Over the past decade, numerous clinical and comparative studies have demonstrated that barbed sutures reduce operative and suturing times, minimize blood loss, and improve surgical ergonomics without increasing complication rates. Their use has been widely adopted in procedures such as total laparoscopic hysterectomy, laparoscopic myomectomy, and pelvic organ prolapse repair, where consistent tissue approximation and hemostasis are critical. The safety profile of barbed sutures is well established, with reported complications such as bowel obstruction or suture extrusion being rare and largely preventable through proper surgical technique. Additionally, barbed sutures contribute to improved cost-effectiveness by reducing operative duration, anesthesia time, and hospital resource utilization. In India, adoption is steadily increasing, driven by favorable outcomes and growing surgeon familiarity, though barriers such as cost and limited training remain. Despite strong evidence supporting their clinical utility, research gaps persist regarding long-term fertility outcomes, uterine scar integrity, and region-specific cost analyses. Future studies should focus on multicentric, randomized trials and standardized training protocols to optimize safety and implementation. Overall, barbed sutures represent a practical, safe, and efficient innovation that aligns with the goals of modern minimally invasive gynecologic surgery.