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Barbed Sutures

Barbed sutures self-anchor along a running closure, reducing knot tying and the need to maintain tension between passes. This reference brings together device characteristics, operative handling, clinical comparisons, and laboratory studies. Manufacturer specifications describe the product; clinical trials address patient outcomes; animal and bench findings explain possible mechanisms without establishing human complication rates. For the broader materials framework, see Sutures.

Product families and manufacturer information​

Product familyManufacturerMaterial and configurationPractical distinction
V-Loc 90MedtronicGlycolide, dioxanone and trimethylene carbonate; unidirectional with loop anchorManufacturer catalog lists absorption at 90–110 days.[1]
V-Loc 180MedtronicGlycolic acid / trimethylene carbonate copolymer; unidirectional with loop anchorCatalog lists approximately 180-day absorption; absorption time is not the duration of full tensile strength.[1]
QuillCorza MedicalUni- and bidirectional configurations; Monoderm (PGA–PCL), PDO or polypropyleneMonoderm and PDO are absorbable; polypropylene is permanent.[33]
STRATAFIXEthicon / J&J MedTechMultiple Spiral and Symmetric designs; formulations include MONOCRYL Plus and PDS PlusChoose by exact product and instructions.[4]
MONOFIXSamyangAbsorbable monofilament with a triangular stopper in the published studyPorcine comparison of mechanical behavior; no urinary-anastomosis outcomes.[5] A 174-patient randomized comparison of MONOFIX-PDO and V-Loc for robotic partial-nephrectomy resection-bed suturing found mean times of 4.5 and 4.8 minutes, respectively (p = 0.531), and reported no device-related adverse events within 90 days; urinary-anastomosis outcomes were not tested.[38]

Product-specific sizing. Corza's Quill catalog recommends one USP size larger than a conventional suture, for example 2-0 Quill when replacing conventional 3-0. Confirm the exact device's instructions, needle, material and required support duration.[33]

A porcine wound-strength comparison by Gingras examined V-Loc 180 and Quill PDO in intradermal closure. Gingras's porcine intradermal comparison measured wound strength, without urinary-anastomosis outcomes.[7]

Biomechanics — What the experiments measured​

A bench comparison of specific 4-0 Quill and PDS samples reported the following measurements:[6]

PropertyBarbed (Quill 4-0)Conventional (PDS 4-0)Clinical implication
Breaking strength11.57 N18.41 NLower breaking strength in these samples
Stiffness172.8 N/mm²128.9 N/mm²Greater stiffness in this test; relevance depends on tissue and device
Suture-line shortening26.6%40.7%Less shortening in this experiment

Holding strength with Hem-o-lok / Lapra-Ty clips for renorrhaphy (Paka 2017):[8]

  • 2-0 V-Loc: 15.9 N in this test
  • 2-0 Stratafix: 13.8 N
  • 2-0 Vicryl: 5.7 N (lower measured holding strength; p < 0.05)

Closure-system testing — Gupta 2016​

Stratafix PGA-PCL with Lapra-Ty clips at 3 weeks.

Gupta 2016 laboratory functional-duration study of closure systems at 4 N tension:[30]

  • Stratafix PGA-PCL with Lapra-Ty/Hem-o-lok: 82% failure at 3 weeks[30]
  • V-Loc 180 with Lapra-Ty/Hem-o-lok: 24% failure at 3 weeks (p < 0.0001)[30]

These results concern the tested formulation, clip arrangement, load and laboratory conditions.[30]

A 100-patient comparison by Cakici and Canda examined bidirectional barbed closure against poliglecaprone with rhabdosphincter reconstruction.[31]

The Upper-Tract Controversy — Pyeloplasty​

Small series and a meta-analysis describe conflicting pyeloplasty experiences. Their technique, product, age group, denominator and failure definitions are important; the reports remain useful despite their limited size.

The alarm signals​

SourcePopulationSutureFinding
Liatsikos 2013 multi-center6 adults, laparoscopic pyeloplastyQuill SRS5 / 6 (83%) recurrent stricture requiring further intervention. The authors advised against the application pending clarification.[2]
Radford 2018 pediatric10 children, robotic pyeloplastyV-Loc for pelvic closure4 / 10 (40%) worsening hydronephrosis requiring restenting (n=1) or redo-pyeloplasty (n=3). All 4 were asymptomatic — failures detected only on imaging. Histology: "plaque-like" inflammatory reaction at the suture line. Vicryl group: 1 / 15 (6.7%) redo for a stent-related complication[3]

The counter-evidence​

SourcePopulationSutureFinding
Sorokin 201613 adults in the barbed group, robotic pyeloplasty4-0 V-LocBarbed (n = 13) and nonbarbed (n = 12) groups; postoperative renography showed no obstruction in 10 of 11 patients with follow-up imaging in each group. A small retrospective comparison.[9]
Anand 2022 meta5 studies—OR time shorter with barbed (p = 0.01); redo-pyeloplasty trend higher but not significant — RR 6.00 (95% CI 0.78–46.14; p = 0.09); no difference in total complications; significant heterogeneity[10]

Interpretation. The wide CI on the redo-pyeloplasty point estimate (0.78–46.14) means the pooled data neither confirm nor refute a 6-fold risk.[10] Quill SRS was involved in the 83% failure series, and V-Loc has produced mixed results.[2][3][9]

Proposed mechanisms and preclinical observations​

MechanismWhy it matters in UPJ / ureter
Suture-line shortening (26.6%)A bench measure of shortening[6]
Tissue cutting by barbsTissue trauma remains a proposed UPJ-stricture mechanism; a prospective series of mixed robotic reconstructive procedures reported tissue cut-through in 5/210 patients, possibly attributable to barbed suture, without establishing pyeloplasty-stricture causation.[37]
Plaque-like inflammatory reactionDescribed in the Radford series[3]
Stone formation on exposed barbsYalcin 2018 rabbit bladder: 4 / 7 on V-Loc vs 1 / 7 on Vicryl at 6 wk (p = 0.039)[11]
Suture migration3 / 7 on V-Loc at 6 wk (p = 0.050)[11]
Irreversible overtighteningThe line resists sliding back; an unsatisfactory pass may need revision rather than further traction
Learning curveLiatsikos noted failures occurred "at least in the initial cases of each surgeon"[2]

The fibrosis paradox​

In Yalcin's rabbit-bladder experiment, the tested barbed suture produced less inflammation and fibrosis histologically than Vicryl or Monocryl (p = 0.010 at 3 wk; p = 0.002 at 6 wk).[11] In contrast, the small upper-tract series described above reported fibrotic narrowing or inflammatory failure after particular barbed-suture repairs.

Vesicourethral anastomosis after minimally invasive prostatectomy​

The accessible 2015 systematic review included three randomized and six observational studies (786 patients) comparing unidirectional barbed with conventional suture for VUA. It found shorter anastomosis time (mean difference −3.98 minutes) and total operative time (−10.06 minutes), but no statistically significant difference in leak, catheter duration, or continence at the reported follow-up intervals.[15] The authors describe a watertight, optimally apposed, tension-free VUA without an intentional gap.[15]

The pooled leak estimate was imprecise (7.08% versus 3.37%; OR 2.17, 95% CI 0.86–5.50), and the review notes variation in technique and limited long-term data.[15]

Individual VUA studies include the randomized comparisons by Zorn, Williams and Sammon and the synthesis by Bai. Williams highlights the importance of tension and technique; Haga examined postoperative MRI tissue findings and urinary outcomes in an observational cohort. These provide useful technical and mechanistic context alongside the pooled clinical evidence.[12][13][14][16][17]

Practical safety framing​

  • Follow the procedure-specific technique, device instructions, and institutional practice.
  • Aim for apposition without ischemic traction. If approximation is unsatisfactory, correct it instead of relying on a generic “run loose” or intentional-gap rule.

Renorrhaphy during partial nephrectomy​

In a 2019 systematic review and meta-analysis of eight cohort studies (431 patients; no eligible randomized trials), barbed suture was associated with lower warm-ischemia time (mean difference −6.55 minutes) and operative time (−11.29 minutes). The same review reported fewer postoperative complications with barbed suture (OR 0.44, 95% CI 0.24–0.80), in contrast to the higher complication rate in the cross-specialty randomized meta-analysis below. Renal-function outcomes were not pooled.[32] Confounding by tumour complexity, surgeon preference, and learning curve remains important.

A later single-centre randomized study assigned 50 selected T1 RAPN patients to double-needle barbed suture or Vicryl. It reported shorter mean warm-ischemia time (11.76 versus 14.56 minutes) and differences in short-term laboratory outcomes, but it was small, limited to selected T1 tumors, and explicitly called for larger multicentre trials.[22]

Interpretation: barbed suture is a reasonable technique to evaluate within an established renorrhaphy workflow.

The broader Bertolo review compares several renorrhaphy strategies, including running versus interrupted and single- versus double-layer repair.[18]

Additional clinical and technical reports​

StudyDesignnWIT (barbed vs conventional)Finding
Olweny 2012Retrospective7826.4 vs 32.8 min (p = 0.001)Bleeding requiring intervention: 3.4% vs 18.4% (p = 0.06)[19]
Erdem 2013Matched-pair6619 vs 28 min (p = 0.037)Inner-layer renorrhaphy time 350 vs 505 sec (p = 0.004)[20]
Liu 2015PADUA-matched8220.7 vs 27.5 min (p < 0.05)Early affected-kidney GFR reduction 20.8% vs 29% (p < 0.05) — observational association[21]
Hu 2025RCT5011.76 vs 14.56 min (p < 0.05)Short-term findings in a small selected cohort[22]
Di Franco 2025Prospective5522.5 min (mean)Novel R-BEP technique with elongated PTFE pledgets; Feasibility findings in the reported cohort[23]

These reports preserve useful operative experience.

Bladder Closure — Mixed Evidence​

Advantages:

  • Gözen 2012 in-vitro fresh cadaver pig-bladder model: running barbed suture had the largest filling volume before leakage (419.7 mL), compared with running Vicryl (353.8 mL) and interrupted Vicryl (276.2 mL) (p < 0.05)[24]
  • Yalcin 2018: less inflammation and fibrosis histologically than Vicryl or Monocryl[11]

Concerns (rabbit bladder model, Yalcin 2018):[11]

  • Stone formation: 4 / 7 on V-Loc 90 versus 1 / 7 on Vicryl at 6 wk (p = 0.039)[11]
  • Suture migration: 3 / 7 on V-Loc 90 at 6 wk (p = 0.050)[11]

Early preclinical urinary reconstruction​

Weld 2006 (earliest preclinical porcine evaluation) tested a prototype self-anchoring suture for pyeloplasty and bladder-neck anastomosis:[25]

  • In-vitro failure force: no difference (13.2 ± 2.6 N versus 14.1 ± 3.1 N; p = 0.22)
  • OR time: no difference[25]
  • Radiographic integrity: no extravasation at 1 wk in any animal
  • Histopathology showed more fibrotic reaction at the experimental bladder-neck anastomosis.[25]

Small Bowel Obstruction — Reported Risk and Denominator Evidence​

Clapp 2020 review of the literature and the MAUDE database identified 18 published cases and 14 MAUDE reports of SBO secondary to barbed suture:[26]

FeatureData
MechanismExposed barbs on suture tail or cut end snag adjacent bowel → internal hernia or volvulus
Mean time to presentation26.3 days postop (range 1–196 d)
Presentation among 18 published casesAbdominal pain 16/18 (88.9%); vomiting 6/18 (33.3%); distension 5/18 (27.8%)
CT findingsMesenteric volvulus 5 cases; strangulation 2
Management in the reported casesThe review concluded that these suture-related obstructions required exploration; laparoscopy succeeded in most

The later Sassun 2026 single-institution retrospective cohort identified 20,260 intra-abdominal operations using barbed suture. Of 264 patients diagnosed with intestinal obstruction, 102 underwent reoperation for obstruction; across 279 abdominal reoperations for any indication, operative-note review attributed none of the obstructions to barbed-suture entrapment. It has no non-barbed comparator. The specific published entrapment cases remain clinically relevant.[34]

When handling suture near mobile bowel, including sacrocolpopexy peritoneal closure, cover or terminate the line according to the specific device and operation, avoiding unintended exposed barbed material. A robotic sacrocolpopexy case report described mesenteric entanglement by a barbed tail with obstruction on postoperative day 4.[36] A loop or stopper does not eliminate risk from a remaining exposed tail.[26][34]

Cross-Field Safety Meta-Analysis​

Lin 2016 meta (17 RCTs, n = 1,992, across all surgical specialties):[27]

  • Suture time ↓ (SMD −0.95; p = 0.0001)
  • Operative time ↓ (SMD −0.28; p = 0.003)
  • Blood loss: no difference
  • Postoperative complications ↑ (OR 1.43; 95% CI 1.05–1.96; p = 0.03)[27]

Su 2023 cosmetic-surgery meta (14 studies, n = 2,259):[28]

  • Wound dehiscence ↑ (OR 1.60; p = 0.02)[28]
  • Suture extrusion ↑ (OR 3.97; p = 0.0001), particularly with unidirectional barbed suture[28]
  • Infection, delayed healing, hematoma: no difference

Decision summary​

SettingFindingsLimits
VUAModest time savings with no demonstrated pooled difference in the reported leak, catheter, or continence outcomes.[15]A universal standard-of-care designation, intentional gapped closure, or superior functional outcome.
RenorrhaphyTime-related benefit is plausible; a small randomized study and older cohort synthesis support further comparative evaluation.[22][32]A universal device, clip, gauge, or long-term renal-function rule.
UPJ/ureter/ureteroenteric repair——
Sacrocolpopexy vaginal mesh attachmentBEST randomized 52 patients: attachment took 13.2 versus 19.7 minutes with barbed versus nonbarbed suture, but missed the prespecified 50% time-reduction target; total operative time was similar.[35] An earlier randomized trial (32 per arm) comparing running Quill with interrupted nonbarbed PDS recorded attachment times of 29 versus 42 minutes; surgeon-rated ease and satisfaction favored nonbarbed PDS, whereas BEST favored barbed suture on those ratings. At 12 months, anatomic failure did not differ significantly in the earlier trial.[39][35]—
Bladder/bowel-adjacent closureHandle exposed material thoughtfully and follow the specific procedure/device guidance.Human complication rates inferred from animal, bench, case-report, or surveillance data.

For injury-specific reconstruction, the ACS genitourinary-trauma guideline is a companion reference.[29]

See Also​

References​

1. Medtronic. V-Loc wound closure device — product catalog. Product characteristics checked September 20, 2026.

2. Liatsikos E, Knoll T, Kyriazis I, et al. "Unfavorable outcomes of laparoscopic pyeloplasty using barbed sutures: a multi-center experience." World J Urol. 2013;31(6):1441–1444. doi:10.1007/s00345-012-1019-6

3. Radford A, Turner A, Ashraf J, Subramaniam R. "Robotic pyeloplasty in children: a 'barbed' shortcut." J Laparoendosc Adv Surg Tech A. 2018;28(4):486–489. doi:10.1089/lap.2017.0494

4. J&J MedTech / Ethicon. STRATAFIX Spiral — manufacturer product information. Accessed September 20, 2026.

5. Kim J, Eom HJ, Shin H, et al. "In vivo comparison of MONOFIX, a novel barbed suture with a triangular stopper, with pre-existing products in a porcine model." J Minim Invasive Gynecol. 2020;27(2):473–481. doi:10.1016/j.jmig.2019.04.005

6. Amend B, Müller O, Bedke J, et al. "Biomechanical proof of barbed sutures for the efficacy of laparoscopic pyeloplasty." J Endourol. 2012;26(5):540–544. doi:10.1089/end.2011.0037

7. Gingras K, Zaruby J, Maul D. "Comparison of V-Loc 180 wound closure device and Quill PDO knotless tissue-closure device for intradermal closure in a porcine in vivo model: evaluation of biomechanical wound strength." J Biomed Mater Res B Appl Biomater. 2012;100(4):1053–1058. doi:10.1002/jbm.b.32670

8. Paka B, Bossemeyer R, Tourojman M, Gupta R, Lane BR. "Holding strength of a Hem-o-lok/Lapra-Ty clip combination on sutures used during partial nephrectomy." Urology. 2017;107:138–143. doi:10.1016/j.urology.2017.06.024

9. Sorokin I, O'Malley RL, McCandless BK, Kaufman RP. "Successful outcomes in robot-assisted laparoscopic pyeloplasty using a unidirectional barbed suture." J Endourol. 2016;30(6):660–664. doi:10.1089/end.2016.0040

10. Anand S, Jukić M, Krishnan N, Pogorelić Z. "Barbed versus non-barbed suture for pyeloplasty via the minimally invasive approach: a systematic review and meta-analysis." J Laparoendosc Adv Surg Tech A. 2022;32(10):1056–1063. doi:10.1089/lap.2021.0868

11. Yalcin S, Kibar Y, Tokas T, et al. "In vivo comparison of 'V-Loc 90 wound closure device' with 'Vicryl' and 'Monocryl' in regard to tissue reaction in a rabbit bladder model." Urology. 2018;116:231.e1–231.e5. doi:10.1016/j.urology.2018.02.027

12. Zorn KC, Trinh QD, Jeldres C, et al. "Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit." BJU Int. 2012;109(10):1526–1532. doi:10.1111/j.1464-410X.2011.10763.x

13. Williams SB, Alemozaffar M, Lei Y, et al. "Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes." Eur Urol. 2010;58(6):875–881. doi:10.1016/j.eururo.2010.07.021

14. Sammon J, Kim TK, Trinh QD, et al. "Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture." Urology. 2011;78(3):572–579. doi:10.1016/j.urology.2011.03.069

15. Li H, Liu C, Zhang H, et al. "The use of unidirectional barbed suture for urethrovesical anastomosis during robot-assisted radical prostatectomy: a systematic review and meta-analysis of efficacy and safety." PLoS One. 2015;10(7):e0131167. doi:10.1371/journal.pone.0131167

16. Bai Y, Pu C, Yuan H, et al. "Assessing the impact of barbed suture on vesicourethral anastomosis during minimally invasive radical prostatectomy: a systematic review and meta-analysis." Urology. 2015;85(6):1368–1375. doi:10.1016/j.urology.2015.02.033

17. Haga N, Kurita N, Yanagida T, et al. "Effects of barbed suture during robot-assisted radical prostatectomy on postoperative tissue damage and longitudinal changes in lower urinary tract outcome." Surg Endosc. 2018;32(1):145–153. doi:10.1007/s00464-017-5649-z

18. Bertolo R, Campi R, Klatte T, et al. "Suture techniques during laparoscopic and robot-assisted partial nephrectomy: a systematic review and quantitative synthesis of peri-operative outcomes." BJU Int. 2019;123(6):923–946. doi:10.1111/bju.14537

19. Olweny EO, Park SK, Seideman CA, Best SL, Cadeddu JA. "Self-retaining barbed suture for parenchymal repair during laparoscopic partial nephrectomy; initial clinical experience." BJU Int. 2012;109(6):906–909. doi:10.1111/j.1464-410X.2011.10547.x

20. Erdem S, Tefik T, Mammadov A, et al. "The use of self-retaining barbed suture for inner layer renorrhaphy significantly reduces warm ischemia time in laparoscopic partial nephrectomy: outcomes of a matched-pair analysis." J Endourol. 2013;27(4):452–458. doi:10.1089/end.2012.0574

21. Liu W, Chen M, Zu X, et al. "The use of self-retaining barbed suture preserves superior renal function during laparoscopic partial nephrectomy: a PADUA score matched comparison." J Laparoendosc Adv Surg Tech A. 2015;25(2):130–134. doi:10.1089/lap.2014.0302

22. Hu X, Miao J, Xie K, et al. "Efficacy and safety of self-retaining double-needle barb suture in transabdominal path robot-assisted laparoscopic partial nephrectomy for T1 renal cancer." BMC Cancer. 2025;25(1):429. doi:10.1186/s12885-025-13825-6

23. Di Franco G, Furbetta N, Guadagni S, et al. "A new renorrhaphy technique using barbed sutures and elongated pledgets for robotic partial nephrectomy." Ann Surg Oncol. 2025. doi:10.1245/s10434-025-18090-2

24. Gözen AS, Arslan M, Schulze M, Rassweiler J. "Comparison of laparoscopic closure of the bladder with barbed polyglyconate versus polyglactin suture material in the pig bladder model: an experimental in vitro study." J Endourol. 2012;26(6):732–736. doi:10.1089/end.2011.0194

25. Weld KJ, Ames CD, Hruby G, Humphrey PA, Landman J. "Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction." Urology. 2006;67(6):1133–1137. doi:10.1016/j.urology.2005.12.022

26. Clapp B, Klingsporn W, Lodeiro C, et al. "Small bowel obstructions following the use of barbed suture: a review of the literature and analysis of the MAUDE database." Surg Endosc. 2020;34(3):1261–1269. doi:10.1007/s00464-019-06890-z

27. Lin Y, Lai S, Huang J, Du L. "The efficacy and safety of knotless barbed sutures in the surgical field: a systematic review and meta-analysis of randomized controlled trials." Sci Rep. 2016;6:23425. doi:10.1038/srep23425

28. Su X, Lin Y, Wu Y, et al. "Effectiveness and safety of knotless barbed sutures in cosmetic surgery: a systematic review and meta-analysis." J Plast Reconstr Aesthet Surg. 2023;87:416–429. doi:10.1016/j.bjps.2023.10.084

29. Johnsen N, Wessells H, Archer-Arroyo K, et al. Best Practices Guidelines: Management of Genitourinary Injuries. American College of Surgeons; 2025.

30. Gupta R, Sunny N, Noyes SL, et al. "Functional duration of closure systems used in partial nephrectomy." J Urol. 2016;196(5):1560–1565. doi:10.1016/j.juro.2016.06.093

31. Cakici OU, Canda AE. "Bidirectional barbed only vs poliglecaprone suture with rhabdosphincter reconstruction for urethrovesical anastomosis during robotic radical prostatectomy: does it make any difference?" J Endourol. 2018;32(10):944–949. doi:10.1089/end.2018.0386

32. Lin Y, Liao B, Lai S, Huang J, Du L, Wang K, Li H. "The application of barbed suture during the partial nephrectomy may modify perioperative results: a systematic review and meta-analysis." BMC Urol. 2019;19(1):5. doi:10.1186/s12894-018-0435-3

33. Corza Medical. Quill barbed suture catalog. Configuration, material and sizing sections checked September 20, 2026.

34. Sassun R, Cerkauskaite D, Sileo A, et al. "Use of barbed suture in surgery and the risk of intestinal obstruction: analysis of a large institutional cohort." Surg Endosc. 2026;40:2914–2918. doi:10.1007/s00464-026-12580-4

35. Gabra M, Woodburn KL, El Haraki A, et al. "BEST: Barbed-suture Efficiency Study for Sacrocolpopexy: A Randomized Clinical Trial." Urogynecology (Phila). 2026;32(8):996–1004. doi:10.1097/SPV.0000000000001768

36. Takagi H, Wada N, Morishita S, et al. "Postoperative small intestinal obstruction caused by barbed suture after robot-assisted laparoscopic sacrocolpopexy." IJU Case Rep. 2024;7(2):105–109. doi:10.1002/iju5.12677

37. Shah HN, Nayyar R, Rajamahanty S, Hemal AK. "Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience." Int Urol Nephrol. 2012;44(3):775–785. doi:10.1007/s11255-011-0075-y

38. Han JH, Jung G, Kim JK, et al. "A randomized trial of MONOFIX® vs. V-loc™ for resection bed suture during robotic partial nephrectomy." BMC Cancer. 2024;24(1):1458. doi:10.1186/s12885-024-13213-6

39. Tan-Kim J, Nager CW, Grimes CL, et al. "A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy." Int Urogynecol J. 2015;26(5):649–656. doi:10.1007/s00192-014-2566-8