Editorial Comment for Seideman et al.

T he objective of barbed sutures when applied to noncutaneous organs is to improve technical efficiency without compromising important patient-specific outcomes. Although there has been adoption and enthusiasm for barbed suture in the orthopedic, gynecologic, urologic, plastics, and general surgery literature, very few have objectively measured meaningful outcomes of interest. While the current report provides a concise explanation on how to use a barbed suture during reconstruction after partial nephrectomy, it is devoid of data supporting its use. A previous report has suggested a 6-minute improvement in warm ischemia time, ¹ which is difficult for me to envision, because the only additional step with traditional sutures is the quick and easy placement of a clip.

The barbed suture has also been incorporated into the vesicourethral anastomosis after radical prostatectomy with similar purported benefits. ² Cogent to this argument and topic, it is worth noting that the best-designed urologic trial (eg, randomized with objective outcomes) suggested that use of barbed sutures for the vesicourethral anastomosis led to greater cost ($51 vs $8), a meaningless improvement in operative time (∼10 sec), and a six-fold increase in extravasation on cystography (20% vs 3%). ³ Hopefully, we will soon see a similar study in patients who are undergoing partial nephrectomy.

Use of a barbed suture without supportive data certainly pales in comparison with more egregious examples of misuse within the practice of medicine and surgery. As surgeons and scientists, however, novel techniques should ideally be supported by evidence-based outcomes. While not always practical, it should remain our goal.