Biomechanical Proof of Barbed Sutures for the Efficacy of Laparoscopic Pyeloplasty
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: The gold standard for management of adult ureteropelvic junction obstruction is laparoscopic dismembered pyeloplasty (LPP), described by Anderson-Hynes, with reduced postoperative complications, early patient release, and favorable results. LPP, however, necessitates a high level of surgical expertise, especially with regard to reanastomosis. Knotless self-anchoring barbed sutures have also been introduced into aesthetic surgery and wound closure. We compared a self-retaining suture (SRS) Quill(®) (Angiotech, Canada) with a standard monofilament suture to further investigate their biomechanical and urodynamic aspects. MATERIALS AND METHODS: We analyzed breaking strength and stiffness between SRS 4.0, 3.0, and polydioxanone suture (PDS(®)) 4.0 (Ethicon, Germany) using a biomechanical testing unit. Urodynamic evaluations were performed in the porcine upper urinary tract, closing a longitudinal incision either with SRS 4.0 (without knots) or with PDS 4.0 (five knots each end). Suture line shortening, suture time, tightness, and intrapelvic pressure were measured. RESULTS: SRS 4.0 breaks at a mean of 11.57 N (standard deviation [SD]=1.25, stiffness 172.8 N/mm(2), SD=10.84), SRS 3.0 at 16.01 N (1.81), and PDS 4.0 at 18.41 N (0.75, 128.9 N/mm(2), 7.45). SRS 4.0 results in a suture line shortening from mean 3.08 to 2.26 mm (-26.6%) while PDS 4.0 shortens from 3.05 to 1.81 mm (-40.7%). The maximum intrapelvic pressure demonstrated no difference, and leakage was seen in 50% of the cases. Suture time was significantly decreased with SRS use (SRS 4.0 277 s and PDS 4.0 364 s). CONCLUSION: SRS offers immediate tissue adaption with reduced suture line shortening and equal tightness compared with nonbarbed material in vitro. Knotless suturing using SRS is time efficient and appears to be an excellent material for LPP.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".