Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses.
Authors: Albanese Valeria, Hanson R Reid, McMaster Mattie A, Koehler Jennifer W, Caldwell Fred J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Barbed Knotless Suture for Laparoscopic Nephrosplenic Space Ablation Laparoscopic closure of the nephrosplenic space is an established preventative strategy for horses at risk of nephrosplenic entrapment (a cause of acute, often surgical colic), but the technical demands of intracorporeal suturing—particularly knot-tying within the abdomen—have historically limited adoption. This study evaluated whether a unidirectional barbed, absorbable suture (0 metric glycolic acid/trimethylene carbonate copolymer) could simplify the procedure by eliminating the need for intracorporeal knot tying. Eight healthy horses underwent laparoscopic nephrosplenic space closure with the barbed suture applied in simple continuous fashion (cranial-to-caudal); tissue healing was assessed via second-look laparoscopy in two animals at 198–227 days post-operatively and by necropsy in six animals at 69–229 days. Mean total surgery time was 89.6 minutes (suturing alone: 40.4 minutes), and all closures measured approximately 13 cm with complete bridging of mature fibrous tissue between the splenic capsule and nephrosplenic ligament; notably, no residual suture material was visible and the barbs provided secure tissue purchase without need for extracorporeal tension management or knot-tying. The barbed knotless suture offers clear technical advantages—reduced operative complexity and instrument demands—making laparoscopic prophylaxis more accessible; however, clinicians should recognise this represents proof-of-concept in healthy horses, and further investigation in horses presenting with acute nephrosplenic entrapment is essential before widespread clinical adoption.
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Practical Takeaways
- •Barbed knotless sutures eliminate the need for knot tying in laparoscopic nephrosplenic closure, reducing operative time and technical difficulty compared to conventional suturing
- •This technique shows promise for preventive colic surgery in normal horses, but evidence is limited to cadaveric/experimental settings—clinical validation in horses presenting with recurrent colic is needed before widespread adoption
- •The barbs provide reliable tissue grip without requiring constant tension management, making this potentially more user-friendly for laparoscopic surgeons during intracorporeal suturing
Key Findings
- •Barbed knotless suture successfully closed nephrosplenic space in all 8 horses with mean surgery time of 89.6 minutes and mean suturing time of 40.4 minutes
- •Closure measured 12-14 cm in length and consisted of mature fibrous tissue at follow-up (days 69-229)
- •No residual suture material was identified grossly and the barbs provided excellent tissue purchase without need for extracorporeal management or intracorporeal knot tying
- •Procedure was technically feasible but study limited to normal horses; clinical efficacy in affected horses remains to be demonstrated