The V-Loc PBT (polybutester) wound closure device from Covidien is described by the firm as the first non-absorbable knotless barbed suture. Designed to enable surgeons to securely close incisions without tying knots, the V-Loc PBT joins the company’s family of absorbable wound closure devices: the V-Loc 90 and the V-Loc 180. Both of those have been shown in studies to enable surgeons to close wounds in as little as half the time compared to conventional sutures while maintaining an equivalent holding strength. In addition, both of those products were honored by Surgical Products Magazine with its “Excellence in Surgical Products Award” for 2011.
Medgadget had the chance to chat with Peter Schommer, vice president, global product marketing, wound closure at Covidien and David Kim, MD, FACS, FASMBS, Forest Park Medical Center (Dallas, TX), who is familiar with the product. “[The V-Loc PBT] has the potential to help a lot of people who struggle with knot typing,” Dr. Kim said, adding that:
[The V-Loc PBT] is definitely unique. […] These sutures allow surgery to be more expeditious. It also may provide an equal level of tissue proximation throughout. Because you are not constantly having to pull up on suture, I think you have sort of a constant tension throughout the same suture line. I believe that the tying exists throughout the suture prettty much obviates the need, in most cases, of an assistant pulling tension let’s say on a prolene suture so it doesn’t get undone.
Peter Schommer explains that “[Covidien sees essentially] two pockets of adoption [for the product]. [In addition to on laparoscopic use], we see it in addition to oversewing staples lines in bariatric surgery, it definitely has some good adoption in neurology and some some good adoption in gynecological procedures—everything from urethral anastomosis, wedge resection, partial nephrectomy, vaginal cuff closure, myomectomy closure in OB/GYN procedures. It’s probably been used in many, many other procedures. But those seem to be some of the main pockets of adoption.
“The consistent thing we hear back from our surgeon customers is that we’ve made laparoscopic suturing easier, which does help surgeons like Dr. Kim who have already adopted technique to be more efficient in their use of time. It also helps surgeons who are struggling with that transition from open surgery to laparoscopic surgery make that transition more effective. We’re taking an issue of laparoscopic knot tying off the table with the device.
“The other big pockets of adoption we see around dermal closure, obviously that is largely associated with plastic surgery: abdominalplasty, breast reductions. But we also see the product being used by obstetricians for closing the dermal layers in cesarean sections. We’ve had some good adoption in orthopedics around closure of the muscle layers and the dermal layers after after a total-hip or total-knee replacement. Again, it’s that idea of facilitating both the time and the technique on suturing. That’s probably the common theme to both of those pockets of adoption.
“We tend to think that nonresorbable would be popular in the laparoscopic application, just given that there’s more use of permanent suture in those types of procedures. But, again, depending on the patient and the anatomy and the surgeons’ judgement, we do occasionally see use in a multi-layer dermal closure use of a nonresorbable in that deep layer where they want kind of that permanent strength.”
Medgadget asked how the device compares to the Quill knotless tissue-closure device. Schommer answered by explaining that:
Quill is a barbed bidirectional suture vs. a unidirectional suture. So, in regular suture, there are both single-arm and double-arm sutures. In terms of how they are regularly used, single-arm suture is the market. Most procedures are done with a single-needled suture. So, I would have to say that the V-Lock is a more intuitive product. It’s allowing surgeons to do the procedure the way that they used to. They don’t have to change their technique. Adding the barbs into that is really an additional feature, but it’s not requiring a technique change to adopt. Whereas with Quill, with the bidirectional approach, you have to start in the middle of the wound and you have to suture in two directions out. You are bringing a second needle in, so there’s an extra sharp you have to account for in the surgery. Those are the obvious differences. There are some differences also in how we cut the barbs and in the density of the barbs. At Covidien, you know, we’ve done our science and believe that we have the better barb geometry, barb density, barb patterns to that. [The Quill product and the V-Loc PBT] are similar on the surface in that they are both barbed devices. We just think our performs a lot better and a lot more intuitively.
Dr. Kim added that he remembers using the Quill device once in vivo before and didn’t find it intuitive to use. “It doesn’t allow a person to sew with natural wrist movements that in laparoscopic surgery is so vital.”