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    Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature. Gülbitti Haydar Aslan,Colebunders Britt,Pirayesh Ali,Bertossi Dario,van der Lei Berend Plastic and reconstructive surgery BACKGROUND:In 2006, Villa et al. published a review article concerning the use of thread-lift sutures and concluded that the technique was still in its infancy but had great potential to become a useful and effective procedure for nonsurgical lifting of sagged facial tissues. As 11 years have passed, the authors now performed again a systematic review to determine the real scientific current state of the art on the use of thread-lift sutures. METHODS:A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database and using the Medical Subject Headings search term "Rhytidoplasty." "Rhytidoplasty" and the following entry terms were included by this Medical Subject Headings term: "facelift," "facelifts," "face Lift," "Face Lifts," "Lift," "Face," "Lifts," "Platysmotomy," "Platysmotomies," "Rhytidectomy," "Rhytidectomies," "Platysmaplasty," "and "Platysmaplasties." The Medical Subject Headings term "Rhytidoplasty" was combined with the following search terms: "Barbed suture," "Thread lift," "APTOS," "Suture suspension," "Percutaneous," and "Silhouette suture." RefWorks was used to filter duplicates. Three of the authors (H.A.G., B.C., and B.L.) performed the search independently. RESULTS:The initial search with all search terms resulted in 188 articles. After filtering the duplicates and the articles about open procedures, a total of 41 articles remained. Of these, the review articles, case reports, and letters to the editor were subsequently excluded, as were reports dealing with nonbarbed sutures, such as Vicryl and Prolene with Gore-Tex. This resulted in a total of 12 articles, seven additional articles since the five articles reviewed by Villa et al. CONCLUSIONS:The authors' review demonstrated that, within the past decade, little or no substantial evidence has been added to the peer-reviewed literature to support or sustain the promising statement about thread-lift sutures as made by Villa et al. in 2006 in terms of efficacy or safety. All included literature in the authors' review, except two studies, demonstrated at best a very limited durability of the lifting effect. The two positive studies were sponsored by the companies that manufacture the thread-lift sutures. 10.1097/PRS.0000000000004101
    The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis. Lin Yifei,Long Youlin,Lai Sike,Zhang Yonggang,Guo Qiong,Huang Jin,Du Liang Obesity surgery BACKGROUND:Knotless barbed sutures can eliminate knot tying during the bariatric surgery (BS). Since effects reported on patients and surgeons are ambiguous, this study is determined to identify the effectiveness and safety of knotless barbed suture in BS. METHODS:PubMed, EMBASE, Cochrane Register of Clinical Studies, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) and cohort studies comparing barbed sutures with conventional sutures in BS (until July 2, 2018). Quality assessment was conducted due to Cochrane's recommendations. Review Manager was applied to analyze the data, and we performed subgroup analyses based on study design type and surgery type. RESULTS:A total of four cohort studies (25,505 patients, low to moderate risk of bias) and four RCTs (1480 patients, low to moderate risk of bias) proved eligible. BS includes laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Comparing to conventional suture, pooling data showed that suture time (MD = - 4.87, 95%CI - 8.82 to - 0.92, P = 0.02) and operative time (MD = - 7.88, 95%CI - 14.10 to - 1.67, P = 0.01) declined significantly in the barbed group. Although no significant change was in the overall postoperative complications and hospital stay, subgroup analysis of RCTs suggested that significantly, fewer bleeding conditions happened in barbed groups. CONCLUSIONS:Although quality of all the studies was relatively moderate and the number of the included studies was limited, the barbed suture may have the potentiality to be an effective and reliable technique and extend the application in other bariatric surgeries. More evidence with randomized design, larger sample sizes, and longer follow-up need to compel validations of this state-of-the-art in the future. 10.1007/s11695-019-03744-4
    Role of Barbed Sutures in Repairing Uterine Wall Defects in Laparoscopic Myomectomy: A Systemic Review and Meta-Analysis. Zhang Yuan,Ma Ding,Li Xiong,Zhang Qinghua Journal of minimally invasive gynecology As an innovative technology barbed sutures have demonstrated clinical and surgical benefits in several specialties. The purpose of this study was to systemically review the available evidence on the application of barbed sutures in repairing the uterine wall defects in laparoscopic myomectomy and to compare with conventional suture in clinical safety and efficacy. Medline, Embase, and Cochrane Database of Systematic Reviews were used for a systematic electronic search of published literature. Studies were selected that evaluate barbed sutures in surgical treatment for patients with benign myomas eligible for laparoscopic myomectomy in comparison with conventional sutures. Depending on the heterogeneity, either a fixed-effects model or random-effects model was used in this meta-analysis. Continuous variable data were showed as standard mean difference (SMD) and weighted mean difference with 95% confidence interval (CI). A total of 7 studies (n = 484) met inclusion criteria. Compared with conventional sutures, barbed sutures demonstrated significant reductions in suturing time (SMD, -1.26; 95% CI, -1.85 to -.67; p < .001), operating time (SMD, -.64; 95% CI, -.83 to -.44; p < .001), intraoperative blood loss (SMD, -.43; 95% CI, -.79 to -.06; p = .021), and postoperative hemoglobin drop (SMD, -.56; 95% CI, -1.01 to -.11; p = .014). The result was numerically lower in the barbed suture group for hospital length of study, although there was no significant difference. This meta-analysis demonstrates clear clinical advantages of time savings and blood loss reduction by using barbed sutures in close uterine wall defects in laparoscopic myomectomy compared with conventional sutures. Those benefits may reduce the surgical difficulty in laparoscopic myomectomy procedures. 10.1016/j.jmig.2016.03.008
    The use of barbed suture for laparoscopic hysterectomy and myomectomy: a systematic review and meta-analysis. Tulandi Togas,Einarsson Jon I Journal of minimally invasive gynecology We conducted a meta-analysis comparing the efficacy of laparoscopic suturing with or without barbed suture for myomectomy or hysterectomy. We used a systematic electronic search strategy of published literature using the following databases: Cochrane Database of Systematic Reviews, MEDLINE, Embase, and OVID MEDLINE In-Process & Other Non-Indexed Citations databases. The following medical subject heading terms, key words, and their combinations were used: laparoscopy, myomectomy, hysterectomy, and barbed suture. Studies in which women undergoing laparoscopic myomectomy or hysterectomy using barbed suture or conventional suture were selected. The main outcome measures chosen for the current meta-analysis were operative time, suturing time, estimated blood loss or change in hemoglobin level, and degree of suturing difficulty. The results of the meta-analysis studies were expressed as the standardized mean difference (SMD) with 95% confidence intervals (CIs). Compared with the use of conventional suture, the total operative time of laparoscopic myomectomy (SMD = -0.58; 95% CI, -0.88 to -0.28) and the suturing time to close the uterine incision (SMD = -1.38; 95% CI, -1.86 to -0.90) were significantly reduced with the use of barbed suture. Meta-analysis on laparoscopic hysterectomy shows that the time to suture the vaginal vault, the total operative time, and the estimated blood loss were comparable with or without the use of barbed suture. The degree of suturing difficulty was reported in 2 randomized trials. Compared with the use of conventional suture, the degree of suturing difficulty was lower with the use of barbed suture (SMD = -1.39; 95% CI, -1.83 to -0.95). The use of barbed suture facilitates laparoscopic suturing of myomectomy incision and closure of the vaginal vault. Its use is associated with a reduced operative time of laparoscopic myomectomy. 10.1016/j.jmig.2013.09.014
    Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: A systematic review and meta-analysis. Lin Yi-Fei,Lai Si-Ke,Liu Qin-Yu,Liao Bang-Hua,Huang Jin,Du Liang,Wang Kun-Jie,Li Hong The Kaohsiung journal of medical sciences As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = -8.52, 95% confidence interval (CI) = -12.60 to -4.43, p < 0.0001] and length of hospital stay (MD = -0.96, 95% CI = -1.80 to -0.11, p = 0.03) were significantly shorter in the barbed group. Results of continence rate varied according to different studies. Subgroup analysis by type of MIRP suggested that patients who underwent barbed suture during robot-assisted surgeries had a shorter hospital stay (MD = -1.13, 95% CI = -1.82 to -0.45, p = 0.001). During the laparoscopic surgery, patients in the barbed suture group had fewer postoperative complications [odds ratio = 0.29, 95% CI = 0.08-0.98, p = 0.05). However, more evidence is needed to validate this state-of-the-art technology. 10.1016/j.kjms.2016.12.005
    The Efficacy and Safety of Knotless Barbed Sutures in the Surgical Field: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Lin Yifei,Lai Sike,Huang Jin,Du Liang Scientific reports The knotless barbed suture is an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. However, the outcomes of previous studies are still confounding. This study reviewed the application of different types of barbed sutures in different surgeries. We searched PubMed, EMBASE, CENTRAL and ClinicalTrials.gov to identify randomized controlled trials (RCTs) addressing the application of barbed sutures up to Feb. 2015. Two reviewers independently screened the literature and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Sensitivity analysis and subgroup analysis was performed. Seventeen RCTs (low to moderate risk of bias) involving 1992 patients were included. Compared with conventional sutures, the barbed suture could reduce suture time (SMD=-0.95, 95%CI -1.43 to -0.46, P = 0.0001) and the operative time (SMD=-0.28, 95%CI -0.46 to -0.10, P = 0.003), not significantly increase the estimated blood loss (SMD=-0.09, 95%CI -0.52 to 0.35, P = 0.70), but could lead to more postoperative complications (OR = 1.43, 95%CI 1.05 to 1.96, P = 0.03), These results varied in subgroups. Thus, barbed sutures are effective in reducing the suture and operative time, but the safety evidences are still not sufficient. It need be evaluated based on special surgeries and suture types before put into clinical practice. 10.1038/srep23425
    Barbed suture versus traditional suture in primary total knee arthroplasty: A systematic review and meta-analysis of randomized controlled studies. Li Pengbiao,Zhang Wenhui,Wang Yanyan,Li Jinlong,Yan Peijing,Guo Shifang,Liu Jie,Yang Kehu,He Zongru,Qian Yaowen Medicine BACKGROUND:Barbed suture has been widely used in some surgical fields, and it has achieved good results, but the application in total knee arthroplasty is still controversial. OBJECTIVE:Literature is collected for statistical analysis so as to provide evidence for the use of barbed suture in Total knee arthroplasty. METHODS:We searched PubMed, the Cochrane library and EMBASE database for randomized controlled trials (RCTs) using barbed suture and conventional suture to close incisions after primary total knee arthroplasty, and the retrieval time was from July 2019 to the establishment of the database. Literature was screened according to inclusion and exclusion criteria, quality evaluation and data extraction were conducted for the final included literature, and statistical analysis was conducted using RevMan 5.3 software. RESULTS:A total of six RCTs (826 knees) were included in our meta-analysis. The results showed that the re-negative conversion could shorten the wound closure time (MD -4.41, 95% CI -5.11 to -3.72, P < .00001) and reduce the wound closure total cost (MD -282.61, 95% CI -445.36 to -119.85, P = .0007) and acupuncture injury (RR 0.14, 95% CI 0.03-0.78, P = .02), and did not significantly increasing the incidence of complications (RR 0.80, 95% CI 0.05-0.96, P = .38) or suture breakages (RR 4.58, 95% CI 0.16-128.29, P = .37). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD -0.74, 95% CI -4.19 to 2.71, P = .67; MD -0.30, 95% CI -2.62 to 2.02, P = .80) and no significant differences in KSS at postoperative 6 weeks (MD -0.22, 95% CI -3.10 to 2.66, P = .88). CONCLUSIONS:Our study shows that barbed suture is a fast, low-cost, safe and effective suture method in total knee arthroplasty compared with traditional suture, we also need more literature and longer follow-up to confirm this conclusion. 10.1097/MD.0000000000019945
    Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method: Systematic Review and Meta-Analysis. Shin Jin Yong,Kim Jin Soo,Roh Si-Gyun,Lee Nae-Ho,Yang Kyung-Moo Plastic and reconstructive surgery BACKGROUND:The barbed suture technique uses newly developed materials for flexor tendon repair. In this study, the authors examine the effectiveness of using barbed sutures in flexor tendon repair compared with conventional methods. METHODS:A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Barbed suture and conventional suture methods were extracted as predictor variables, and maximum force, gap formation force, and cross-sectional area were extracted as outcome variables. Subgroup analyses were performed according to the source of suture materials and the number of strands. The Newcastle-Ottawa Scale was used to assess the quality of studies. Publication bias was evaluated using funnel plots. RESULTS:The search strategy identified 86 publications. After screening, 12 articles were selected for review. Barbed sutures are comparable in effectiveness to conventional methods in terms of maximum force, gap formation force, and cross-sectional area. In the subgroup analysis, barbed sutures also have comparable effects to conventional methods in terms of maximum force and gap formation force. CONCLUSIONS:The authors' meta-analysis found that the use of barbed sutures in flexor tendon repair was competitive compared to conventional methods in terms of maximum force and gap formation force. Long-term in vivo studies are needed to confirm these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V. 10.1097/PRS.0000000000002573
    The Implications of Barbed Sutures on Scar Aesthetics: A Systematic Review. Motosko Catherine C,Zakhem George A,Saadeh Pierre B,Hazen Alexes Plastic and reconstructive surgery BACKGROUND:Barbed sutures have become increasingly popular in the field of aesthetic plastic surgery, particularly in body contouring and breast operations, in which the use of barbed sutures may offer both time and cost savings. Scar aesthetics is an important outcome for both surgeons and patients in these procedures; however, there is a paucity of studies assessing the aesthetic outcome of barbed sutures with regard to scarring. METHODS:A systematic review of the PubMed, EMBASE, and Cochrane databases was performed from the date of their inception through July of 2017 using the search terms "barbed suture" combined with "scar" or "wound." Studies were included if they were prospective, evaluator-blind, randomized, controlled trials; closed the dermal layer of incisions using barbed sutures; and included an evaluator-blind aesthetic assessment of scarring. RESULTS:Six prospective, randomized, controlled trials met inclusion criteria. The cosmetic result of scars in 926 patients was evaluated after an average of 8.1 months. Five of the six controlled trials found the aesthetic results of wounds closed with barbed sutures to be equivalent to those closed with traditional sutures, and one study showed significantly superior aesthetic results with barbed sutures. Use of barbed sutures resulted in shorter operating times in four of the five studies that timed incision closure. Similar complication rates were observed in all evaluated studies. CONCLUSION:Based on this systematic review, the majority of studies concluded that there were no differences in scarring aesthetics when dermal layers were closed using barbed sutures compared with traditional suturing techniques. 10.1097/PRS.0000000000004552
    Barbed versus standard sutures in total knee arthroplasty: a meta-analysis. Meena Sanjay,Gangary Shreesh,Sharma Pankaj,Chowdhury Buddhadev European journal of orthopaedic surgery & traumatology : orthopedie traumatologie INTRODUCTION:The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty. METHODS:We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs. RESULTS:Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36-2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI -2.74, CI -3.06, -2.42, P < 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time. CONCLUSION:Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures. 10.1007/s00590-015-1644-z
    The Role of Knotless Barbed Suture in Gynecologic Surgery: Systematic Review and Meta-Analysis. Iavazzo Christos,Mamais Ioannis,Gkegkes Ioannis D Surgical innovation Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures. 10.1177/1553350614554235
    What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation. Gardella Barbara,Dominoni Mattia,Iacobone Anna Daniela,De Silvestri Annalisa,Tinelli Carmine,Bogliolo Stefano,Spinillo Arsenio Gynecologic and obstetric investigation BACKGROUND:This work analyzes the feasibility and effectiveness of barbed suture during laparoscopic myomectomy. METHODS:Eight works have been carefully examined for the meta-analysis from all papers published online until November 2017. RESULTS:Barbed suture proved to be superior to traditional suture technique in blood loss in laparoscopic myomectomy (Standardized Mean Difference [SMD] -0.650, 95% CI -1.420 to -0.119, p = 0.098, test for heterogenity p < 0.0001, I2 = 95.54%), Hb drop (SMD -1.452, 95% CI -3.590 to 0.687, p = 0.183, test for heterogenity p < 0.0001, I2 = 99.08%), suturing difficulty (SMD -0.638, 95% CI -0.935 to -0.342, p ≤ 0.001, test for heterogenity p = 0.25, I2 = 27.84%), suturing time (SMD -1.197, 95% CI -1.848 to -0.549, p ≤0.001, test for heterogenity p = 0.0001, I2 = 83.30%) and total operative time (SMD -0.687, 95% CI -0.804 to -0.569, p ≤ 0.001, test for heterogenity p = 0.292, I2 = 17.44%). Barbed suture demonstrated to be better in comparison with the control group even with regard to the length of hospitalization (SMD -0.278, 95% CI -0.543 to 0.012, p = 0.040, test for heterogenity p = 0.025, I2 = 61.85%), and to perioperative complications (SMD 0.708, 95% CI 0.503-0.996, p = 0.048, test for heterogenity p = 0.79, I2 = 0%). CONCLUSION:Barbed suture significantly facilitates laparoscopic myomectomy by reducing the total operative/suturing time, estimated blood loss/Hb drop, and reduction of perioperative complications. 10.1159/000488241
    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 Huixin,Liu Chunxiao,Zhang Haibin,Xu Wenfeng,Liu Jianhua,Chen Yong,Li Tangxuan,Li Bin,Wu Zhenquan,Xia Taolin PloS one 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. 10.1371/journal.pone.0131167