Suture techniques Archives - Revista Brasileira de Ginecologia e Obstetrícia
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Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):603-608
, , , , , , , To evaluate the performance of residents in gynecology and obstetrics before and after practicing laparoscopic sutures, to establish when the training shows the best results, in addition to comparing whether being in different years of residency influences this progression.
A prospective cohort study involving 32 medical residents evaluated with a pretest to establish their previous knowledge in laparoscopic suture. This test consisted of knotting two wires, one made of polypropylene and the other of polyglactin, with a blocking sequence of five semi-knots. We set a 30-minute limit to complete the task. Then, the residents held four training meetings, focusing on suture, Gladiator rule, knot, and symmetries, in addition to executing blocking sequences. A second test to establish progress was performed.
Regarding the time spent to make the stiches using polyglactin wire, a statistically significant time improvement (p< 0.01) was observed, with a 10.67-minute pretraining median (mean 12.24 minutes) and a 2.53-minute posttraining median (mean 3.25 minutes). Regarding the stitches with polypropylene wire, a statistically significant time improvement (p< 0.05) was also observed, with a 9.38-minute pretraining median (mean 15.43 minutes) and a 3.65-minute posttraining median (mean 4.54 minutes). A total of 64.2% of the residents had been able to make the knot with polypropylene previously. One hundred percent were able to complete the task in the posttest.
Model training using the Gladiator rule for laparoscopic suture improves the knotting time with statistically similar performance, regardless of the year of residency, after systematic training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):603-608
, , , , , , , To evaluate the performance of residents in gynecology and obstetrics before and after practicing laparoscopic sutures, to establish when the training shows the best results, in addition to comparing whether being in different years of residency influences this progression.
A prospective cohort study involving 32 medical residents evaluated with a pretest to establish their previous knowledge in laparoscopic suture. This test consisted of knotting two wires, one made of polypropylene and the other of polyglactin, with a blocking sequence of five semi-knots. We set a 30-minute limit to complete the task. Then, the residents held four training meetings, focusing on suture, Gladiator rule, knot, and symmetries, in addition to executing blocking sequences. A second test to establish progress was performed.
Regarding the time spent to make the stiches using polyglactin wire, a statistically significant time improvement (p< 0.01) was observed, with a 10.67-minute pretraining median (mean 12.24 minutes) and a 2.53-minute posttraining median (mean 3.25 minutes). Regarding the stitches with polypropylene wire, a statistically significant time improvement (p< 0.05) was also observed, with a 9.38-minute pretraining median (mean 15.43 minutes) and a 3.65-minute posttraining median (mean 4.54 minutes). A total of 64.2% of the residents had been able to make the knot with polypropylene previously. One hundred percent were able to complete the task in the posttest.
Model training using the Gladiator rule for laparoscopic suture improves the knotting time with statistically similar performance, regardless of the year of residency, after systematic training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):655-661
To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique.
Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019.
Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method.
The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):655-661
To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique.
Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019.
Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method.
The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):465-470
To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS).
Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using lowcost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques.
The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction.
The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):465-470
To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS).
Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using lowcost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques.
The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction.
The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(2):92-95
Nowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(2):92-95
Nowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):633-638
DOI 10.1590/S0100-72032007001200006
PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):633-638
DOI 10.1590/S0100-72032007001200006
PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
