Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Comparative Study
Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy.
The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. ⋯ We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications.
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The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). ⋯ What are the implications of these findings for clinical practice and/or further research? The delivery of multi-disciplinary team training for all healthcare staff involved in the complex management of medical conditions in pregnancy can help develop a greater understanding of others' professional roles, and demonstrate the importance of interprofessional teamwork. Furthermore, it provides the space to reflect on team working approaches, including the leadership and professional autonomy, and their potential impact on patient care. Future research should evaluate the impact of this training on the objective outcome measures of medical emergencies in pregnancy.