New technique of uterine closure at C section with barbed suture



in the case presented in this video the double-layer technique using strata fix bi-directional knotless tissue control device spiral PD o the in silent trend size one mounted on a forty eight millimeter half circle is used to close the uterine incision the not less tissue control device is prepared by mounting the needles on either side on the separate needle holders and a place on the tray for surgical instrument in this case exteriorization of the uterus is used to facilitate exposure the first layer of the uterine closure is started using one needle at one end of the incision a full thickness of the uterine wall is included in the first needle pass to secure the angle of the incision the suture material read then pulled gently until the midpoint catch is felt no attempt is made to adjust the tension on the suture at this point a couple of needle passes are their main in the uterine incision excluding the residual whenever possible and including the deeper portion of the uterine wall at this point a moderate tension is done by the surgeon himself on the suture in between the needle passes to maintain a uniform tension on the suture line it is to be remembered the attend assistance should not pull on the suture at any time during closure as the anchors provided in the suture device maintain the desired tension in between the needle passes ideally the one centimeter distance between the needle passes is maintained during closure technique AB deserve that because of the gentle tension applied by the surgeon himself in between the needle passes the possibility of tearing of the uterine muscles is minimal as compared to the conventional technique using the other suture material where attention is maintained by the assistant exerting unnecessary force on the suture at all time this has a negative impact on the incidence of tearing of the uterine muscles during suturing and consequently the need of additional suturing and a bleeding from the edge of the wound when reaching the other end of the Train incision locking of the suture device is done by a couple of reversed or back stitches and the suture is then cut flush with the uterine wall the second layer is performed in the same way starting from the same end of the incision using the other needle in this layer the superficial part of the uterine muscles and the visceral peritoneum are included the same procedure is performed as in the first layer keeping approximately one centimeter distance between the needle passes and also applying gentle mother traction on the suture in between the needle passes without any assistance at any time is to be noted that the absence of the hand of the assistant in the field allows clear surgical site at all time you the presence of anchors along the suture device allows uniform and a consistent tension without the need of naughty the stability provided by the barbed suture is similar to that of interrupted suturing technique but in a continuous situation fashion this contributes to the significant reduction in your enclosure time thus minimizing bleeding from the edge of the uterine incision when reaching the other end of the uterine incision locking of the suture device is done by a couple of reverse or back stitches and the suture is then cut flush with the uterine muscles and the procedure is terminated observe the perfect hemostasis at the end of the procedure without the need of any naughty also the absence of any suture material exposed on the outer surface of the uterine incision

3 Replies to “New technique of uterine closure at C section with barbed suture”

  1. sir what about the increased chances of inflammation with the barbed suture in the uterine tissue?will you please comment on that?how has your experience been while reoperating a patient in whom the previous closure was done with barbed suture?

  2. Amazing suture Prof Mohamed . Secure ,safe and easy . Have you any experience with SFX Symmetric for fascia clouser Prof.Mohamed ?we would love to hear your feedback dear Prof Mohamed .

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