Durability of Sutures Used in Partial Nephrectomy: Tested Across Commonly Used Diameters and Materials Stopped with LAPRA-TY® Suture Clips and Hem-o-Lok® Ligation Systems under a Given Tension

The primary healing of soft tissue incision advances in the first fourteen days after surgery. Sutures used to close the incision are terminated with knots to last over this period under tension inside the tissue. However, knots significantly reduce the tensile strength of the sutures, and make the surgery closing time longer and tedious. Suture clips are used to overcome these limitations. It was found in prior researches that sutures slip out of the suture clips, although the manufacturer of the LAPRA-TY® suture clips claims endurance of this product under tension for at least fourteen days. Use of suture clips and ligation systems together to terminate sutures was found to endure more tension than using only knot or only clip. This calls for an investigation on the durability of different types and sizes of sutures stopped with suture clips and ligation systems under a tension used to control bleeding and urine leakage following partial nephrectomy. This research examined the tension durability of synthetic absorbable sutures (smooth and barbed) commonly used in partial nephrectomy, for four weeks under four Newton tension, when stopped with surgeon placed LAPRA-TY® suture clip and Hem-o-Lok® ligation system. The suture samples were prepared with knots and a Hem-o-Lok® at one end, and a Hem-o-Lok® and a LAPRA-TY® at the other end. They were hung vertically (with LAPRA-TY® at the top) in a simulated in vitro environment. Slippage from LAPRA-TY® and Hem-o-Lok® combination at the top was found to be the major mode of failure. Vicryl 0 and Vicryl 2-0 had 100% survival rate over fourteen days, followed by Vicryl 3-0 which had 50% failure before seven days. Vicryl 4-0 and Vicryl 5-0 failed 100% before fourteen days, though manufacturer’s recommendation for the use of LAPRA-TY® includes Vicryl 4-0. Use of more than one LAPRA-TY® or more than one Hem-o-Lok®, tissue closure and suture performance under other tension levels, and durability of other types and sizes of sutures in the same set-up are necessary to be explored