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The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety.

Li H, Liu C, Zhang H, Xu W, Liu J, Chen Y, Li T, Li B, Wu Z, Xia T - PLoS ONE (2015)

Bottom Line: However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China; Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.

Aims: The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.

Methods: We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).

Results: Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45--4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52--0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6-12 months after surgery.

Conclusions: Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

No MeSH data available.


Related in: MedlinePlus

Forest plot and meta-analysis of operative time.UBS = unidirectional barbed suture; CS = conventional non-barbed suture; SD = standard deviation; IV = inverse variance method; CI = confidence interval.
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pone.0131167.g003: Forest plot and meta-analysis of operative time.UBS = unidirectional barbed suture; CS = conventional non-barbed suture; SD = standard deviation; IV = inverse variance method; CI = confidence interval.

Mentions: Results of combined estimates comparing UBS versus CS are shown in Table 2. Eight studies demonstrated the anastomosis time was significantly shorter in UBS group than CS group (WMD:-3.98min; 95% CI, -6.02–-1.95; p = 0.0001) (Fig 2) [15–22]. Of six studies reported operative time [14,15,19–22], the results showed that it was deceased with UBS than CS (WMD:-10.06min; 95% CI, -15.45–-4.67; p = 0.0003) (Fig 3). Five studies performed PR using Rocco stitch [23, 24], but just four of them reported the RP time for meta-analysis [18–20, 22]. And it was significantly reduced with UBS, either (WMD:-0.93min; 95% CI, -1.52–-0.34; p = 0.002) (Fig 4).


The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety.

Li H, Liu C, Zhang H, Xu W, Liu J, Chen Y, Li T, Li B, Wu Z, Xia T - PLoS ONE (2015)

Forest plot and meta-analysis of operative time.UBS = unidirectional barbed suture; CS = conventional non-barbed suture; SD = standard deviation; IV = inverse variance method; CI = confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489906&req=5

pone.0131167.g003: Forest plot and meta-analysis of operative time.UBS = unidirectional barbed suture; CS = conventional non-barbed suture; SD = standard deviation; IV = inverse variance method; CI = confidence interval.
Mentions: Results of combined estimates comparing UBS versus CS are shown in Table 2. Eight studies demonstrated the anastomosis time was significantly shorter in UBS group than CS group (WMD:-3.98min; 95% CI, -6.02–-1.95; p = 0.0001) (Fig 2) [15–22]. Of six studies reported operative time [14,15,19–22], the results showed that it was deceased with UBS than CS (WMD:-10.06min; 95% CI, -15.45–-4.67; p = 0.0003) (Fig 3). Five studies performed PR using Rocco stitch [23, 24], but just four of them reported the RP time for meta-analysis [18–20, 22]. And it was significantly reduced with UBS, either (WMD:-0.93min; 95% CI, -1.52–-0.34; p = 0.002) (Fig 4).

Bottom Line: However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, the First People's Hospital of Foshan (Foshan Affiliated Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China; Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.

Aims: The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.

Methods: We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).

Results: Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45--4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52--0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6-12 months after surgery.

Conclusions: Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

No MeSH data available.


Related in: MedlinePlus