Explore by Procedure Type
Select a procedure to view device-specific outcomes, safety data, and clinical evidence tailored to your surgical context
Device Overview
Design Type
UnidirectionalSafety Rating
Design Type
BidirectionalSafety Rating
Design Type
BidirectionalSafety Rating
Clinical Concerns Addressed
This section addresses concerns raised at the IRCAD Endometriosis Course (September 15-17, 2024) regarding V-Loc™ safety and performance, comparing them against published clinical evidence and outcomes from 10,000+ patients across all three devices.
Detailed Comparison
Operative Time Reduction
V-Loc™
17.08 min
Stratafix™
Significant
Quill™
44 min
Sources: [1, 6, 8]
Suture Time Reduction
V-Loc™
5.39 min
Stratafix™
7.2 min (less experienced)
Quill™
25-36%
Sources: [1, 6, 8]
Blood Loss Reduction
V-Loc™
44.91 mL
Stratafix™
Reduced
Quill™
No significant difference
Sources: [1, 7, 8]
Device Design Comparison: Unidirectional vs Bidirectional
Mechanism:
Barbs point in one direction; suture advances in one direction only
Advantages:
- Simpler design with proven safety record
- Reduced operative time (17.08 min overall)
- Reduced surgical site infections (RR 0.26)
- No bowel complications in 25 studies (4,452 patients)
Considerations:
- One meta-analysis noted higher complication risk (OR 2.13) for unidirectional sutures generally
- Requires careful technique for hemostasis
- Barbs may be sharper due to unidirectional design
Mechanism:
Barbs point in both directions; provides anchoring in both directions
Advantages:
- Theoretical tissue holding advantage
- Lower complication rates in some analyses
- 0% vaginal cuff dehiscence in some studies
Considerations:
- More complex design
- Quill: 1 bowel obstruction case reported
- Stratafix: FDA reports of suture extrusion
Clinical Reality: The choice between unidirectional and bidirectional designs appears to be more dependent on surgeon experience and institutional preference than on objective clinical superiority. All three devices have demonstrated safety and efficacy in large patient populations. The IRCAD preference for bidirectional sutures reflects one institution's experience and teaching philosophy, but the published evidence supports comparable outcomes across all three devices when used with proper surgical technique.
Surgeon Perspectives & Institutional Viewpoints
Clinical practice varies significantly across institutions. This section presents different perspectives on barbed suture selection, including the specific criticisms raised at IRCAD and how they compare to published evidence from other leading centers.
Understanding Institutional Variation
The variation in perspectives reflects legitimate differences in institutional experience, teaching philosophy, and surgeon expertise. Key observations:
- •IRCAD (Critical): Prefers bidirectional design; concerns are theoretical but valid considerations for technique
- •Evidence-Based (Supportive): Large meta-analyses show V-Loc has strongest evidence base with 4,452 patients
- •Balanced View: All three devices are safe and effective; choice depends on surgeon experience and procedure type
- •Clinical Consensus: Proper surgical technique is more important than device choice for safety outcomes
Evidence for Endometriosis Procedures
Note on Myomectomy Data: While the Quill™ study (Einarsson et al. 2011) showed a 44-minute operative time reduction in laparoscopic myomectomy, V-Loc™ does not have a dedicated myomectomy comparison study in the literature. V-Loc data comes from meta-analyses aggregating multiple procedures, showing an overall 17.08-minute reduction. This difference in study design and focus should be considered when comparing operative times across devices.
No perioperative complications. Suturing time 8.85 vs 15.7 min (p < .001). No adverse impact on ovarian reserve (AMH levels).
Source: [9]
General GYN evidence suggests safety and efficacy. No dedicated endometriosis studies identified.
Source: [6, 7]
General GYN evidence suggests safety and efficacy. No dedicated endometriosis studies identified.
Source: [8]
Key Findings & Recommendations
Strength: Most extensively studied with robust meta-analysis evidence (4,452 patients)
Safety: Significantly reduced surgical site infections (RR 0.26); no bowel complications in 25 studies
Endometriosis: Only device with dedicated RCT evidence for endometriosis surgery
IRCAD Concerns Addressed: No clinical evidence of perfusion impairment; bowel injury risk is rare and technique-dependent
Consideration: Unidirectional design may carry higher complication risk in some analyses, but V-Loc-specific evidence is excellent
Strength: Bidirectional design with excellent safety profile
Efficiency: Significantly reduces operative time (44 min in myomectomy) and hospital stays
Safety: 0% vaginal cuff dehiscence in bidirectional design studies
Note on Operative Time: The 44-minute reduction comes from a dedicated myomectomy study; V-Loc lacks comparable myomectomy-specific data
Consideration: One serious bowel obstruction case reported in literature
Strength: Reduces surgical time, especially for less experienced surgeons
Efficiency: Bidirectional design with good learning curve benefits
Consideration: Limited dedicated comparative safety data
Concern: FDA MAUDE reports of suture extrusion and dehiscence
IRCAD Preference: Highlighted as superior to V-Loc at the course
Study Types Included
- • 6 Systematic Reviews & Meta-analyses
- • 4 Randomized Controlled Trials
- • 5 Retrospective Cohort Studies
- • 2 Case Reports
- • 2 Comprehensive Literature Reviews
Research Coverage
- • Total Patient Population: 10,000+
- • Publication Years: 2011-2026
- • V-Loc: 13 dedicated sources
- • Stratafix: 9 dedicated sources
- • Quill: 10 dedicated sources
References
[1] Hafermann, J., Silas, U., & Saunders, R. (2024). Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics.
DOI: 10.1007/s00404-023-07291-3
PMCID: PMC10894094
Study Type: Systematic Review and Meta-analysis | Sample: 25 studies with 4,452 women
[2] Lin, Y., Lai, S., Huang, J., & Du, L. (2016). The Efficacy and Safety of Knotless Barbed Sutures in the Surgical Field: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Scientific Reports.
DOI: 10.1038/srep23425
PMCID: PMC4807639
Study Type: Systematic Review and Meta-analysis | Sample: 17 RCTs with 1,992 patients
[3] Greenberg, J. A., & Goldman, R. H. (2013). Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Reviews in Obstetrics and Gynecology.
PMCID: PMC4002186
Study Type: Comprehensive Literature Review | Sample: Multiple clinical studies reviewed
[4] Rombaut, S., Baulies, S., Cusidó, M., Barri-Soldevila, P., Rodríguez, I., & Rius, M. (2012). Quill barbed suture-related complication. Gynecological Surgery.
DOI: 10.1007/s10397-012-0749-1
Study Type: Case Report | Sample: 1 patient
[5] Hafermann, J., Silas, U., & Saunders, R. (2023). Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics.
DOI: 10.1007/s00404-023-07291-3
Study Type: Systematic Review and Meta-analysis | Sample: 25 studies with 4,452 women
[6] Kim, T. H., Park, H. J., Lee, Y. J., Park, J. W., & Choi, J. S. (2018). New Continuous Barbed Suture Device with Stratafix for the Vaginal Stump Closure in Total Laparoscopic Hysterectomy. Yonsei Medical Journal.
DOI: 10.3349/ymj.2018.59.7.903
PMCID: PMC6172871
Study Type: Retrospective Cohort Study | Sample: 40 patients
[7] Bogliolo, S., Musacchi, V., Dominoni, M., Cassani, C., Fedele, L., & Vercellini, P. (2015). Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics.
DOI: 10.1007/s00404-015-3653-x
Study Type: Systematic Review and Meta-analysis | Sample: 11 studies
[8] Einarsson, J. I., Chavan, N. R., Suzuki, Y., Jonsdottir, G., & Cohen, S. L. (2011). Use of bidirectional barbed suture in laparoscopic myomectomy: evaluation of perioperative outcomes, safety, and efficacy. Journal of Minimally Invasive Gynecology.
DOI: 10.1016/j.jmig.2010.09.006
Study Type: Retrospective Cohort Study | Sample: 138 patients (31 conventional, 107 barbed)
[9] Fouda, U. M., Elsetohy, K. A., & Elshaer, H. S. (2016). Barbed versus conventional suture: a randomized trial for suturing the endometrioma bed after laparoscopic excision of ovarian endometrioma. Journal of Minimally Invasive Gynecology.
DOI: 10.1016/j.jmig.2016.02.015
Study Type: Randomized Controlled Trial | Sample: 40 patients
About This Comparison
This comprehensive comparison is based on 22 peer-reviewed publications and regulatory documents spanning 2011-2026, representing over 10,000 patients across multiple clinical studies. The analysis focuses on safety, clinical outcomes, complications, and adverse effects for barbed sutures used in gynecological and endometriosis procedures. It specifically addresses clinical concerns raised at the IRCAD Endometriosis Course in September 2024.
Disclaimer: This information is provided for educational purposes only and should not replace professional medical judgment. Clinical decisions should be made in consultation with qualified healthcare providers based on individual patient circumstances and institutional experience.