Biomechanical analysis of unidirectional knotless suture loop weld integrity after passage through a cadaveric body wall.

OBJECTIVE: To evaluate the integrity of the welded end loop on unidirectional knotless suture after transabdominal passage in a canine cadaver.

STUDY DESIGN: Ex vivo biomechanical study.

STUDY POPULATION: Four variations of unidirectional knotless suture and 1 canine cadaver.

METHODS: Welded end loop on strands consisted of 0 Quill polydioxanone (QP; n = 22), 0 Quill monoderm (QM; n = 23), 2-0 V-Loc 90 (V9; n = 12), and 2-0 V-Loc 180 (V18; n = 12). Half of the suture strands in each group were passed percutaneously through an insufflated cadaveric body wall, and the remaining half served as intact controls. A linear testing machine was used to load the sutures to failure. Modes of and loads to failure were compared within and between suture types.

RESULTS: Loads to failure did not differ between sutures passed through the body wall and their controls when the loop remained intact. Sutures V9, V18, and QM sustained higher loads to failure compared with QP. All Quill suture lines failed at the weld during testing. Thirty-three percent of QP sutures failed at the weld during initial passage through the body wall. V-Loc sutures failed at the suture-apparatus interface, within the welded loop, or a combination.

CONCLUSION: Passing suture through a cadaveric body wall did not affect the integrity of the welded end loop of any of the unidirectional knotless sutures tested here when the loop remained intact.

CLINICAL SIGNIFICANCE: Unidirectional knotless suture (V9, V18 and QM) can be safely passed through a canine body wall for use in laparoscopic procedures. The use of QP in this manner cannot be recommended.