BEST: Barbed-suture Efficiency Study for Sacrocolpopexy: A Randomized Clinical Trial

Importance Unidirectional barbed suture may decrease suture time for vaginal mesh attachment in robotic sacrocolpopexy. Objective The objective of this study was to evaluate if absorbable unidirectional barbed suture decreases vaginal mesh attachment time compared with nonbarbed suture. Study Design This single-blind, randomized trial of women undergoing robotic sacrocolpopexy for ≥stage 2 symptomatic pelvic organ prolapse assessed if absorbable unidirectional barbed suture resulted in a 50% faster vaginal mesh attachment compared with interrupted nonbarbed suture. Surgeon-reported ease of mesh attachment, appearance of mesh, and global satisfaction with each suture type was assessed with a 10-point Likert scale (1 worst, 10 best). Six-month patient-centered outcomes were assessed. Results In total, 52 participants were randomized, with 25 in the barbed suture group and 27 in the nonbarbed suture group. Vaginal mesh attachment was faster for barbed suture (13.2 vs. 19.7 min, P <0.01). However, this did not reach the primary outcome of a 50% decrease in suture time. When stratified by level of training, barbed suture remained significantly faster for resident and fellow surgeons but not for attending surgeons. Surgeons rated barbed suture higher than nonbarbed suture for ease of suture use and global satisfaction, with similar mesh appearance ratings. Total operative time was similar between groups (186.1 vs. 180.9 min, P =0.62). Six-month patient-centered outcomes were similar between groups. Conclusions Unidirectional barbed suture decreased mesh attachment time compared with nonbarbed suture, especially for novice surgeons. Surgeon satisfaction was higher for barbed suture, and there was a similar improvement in all patient-centered outcomes at 6 months.