Assessing the Impact of Barbed Suture on Vesicourethral Anastomosis During Minimally Invasive Radical Prostatectomy: A Systematic Review and Meta-analysis

OBJECTIVE To examine the effectiveness of barbed suture (BS) compared with conventional sutures for vesicourethral anastomosis (VUA) during minimally invasive radical prostatectomy (RP). METHODS Relevant studies comparing the safety and efficacy of BS with conventional sutures during minimally invasive RP were identified through a literature search using MEDLINE, EMBASE, and the Cochrane Library. The outcome measures included baseline characteristics, primary outcomes, and secondary outcomes. RESULTS Ten studies (378 cases and 369 controls) were included. No significant differences between the 2 groups were detected in any of the baseline variables except for age (P = .02). The BS group had a shorter operation time (mean difference [MD], 10.54; 95% confidence interval [CI], -14.38 to -6.69; P<.01), a shorter VUA time (MD, -5.35; 95% CI, -7.44 to +/- 3.25; P<.01), and a shorter posterior reconstruction time (MD, -0.56; 95% CI, -1.10 to -0.02; P = .04) than those in the conventional sutures group. No significant differences were detected between the 2 groups in other outcomes of interest. In subgroup and sensitivity analyses, there was no change in the significance of any of the outcomes. CONCLUSION This meta-analysis indicates that VUA using BS as opposed to conventional suture is associated with a shorter operative time, comparable postoperative complication rate, and convenience for manipulation, which is of benefit to the surgeon learning robot-assisted RP and laparoscopic RP. Given that the inherent limitations, future well-designed randomized controlled trials are required to confirm our findings. (C) 2015 Elsevier Inc.