Quill^™ Self-Retaining System

A member of the Reviews in Obstetrics & Gynecology editorial board reviewed the following devices. The views of the author are personal opinions and do not necessarily represent the views of Reviews in Obstetrics & Gynecology or MedReviews®, LLC.

Companies can submit a product for review by e-mailing molson@medreviews.com.

• Design/Functionality Scale

  • 1 = Poor design; many deficits
  • 2 = Solid design; many deficits
  • 3 = Good design; few flaws
  • 4 = Excellent design; few flaws
  • 5 = Excellent design; flaws not apparent
• Innovation Scale

  • 1 = Nothing new
  • 2 = Small twist of standard technology
  • 3 = Major twist on standard technology
  • 4 = Significant new technology
  • 5 = Game changer
• Value Scale

  • 1 = Added cost with limited benefit
  • 2 = Added cost with some benefit
  • 3 = Added cost but significant benefit
  • 4 = Marginal added cost but significant benefit
  • 5 = Significant cost savings
• Overall Scale

  • 1 = Don’t bother
  • 2 = Niche product
  • 3 = Worth a try
  • 4 = Must try
  • 5 = Must have

Evaluation

Design/Functionality: 4

Innovation: 5

Value: 5

Overall Score: 4.5

Background

Suture technology, although often overlooked, should be of major interest to anyone who performs operations.

According to the package insert, “(t)he Quill^™ Self-Retaining System (SRS) [Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada] consists of barbed suture material, armed with a surgical needle on each end. Barbs allow for tissue approximation without the need to tie surgical knots.”¹ It is easy to glance over a crucial line in the history of surgical suture: without the need to tie surgical knots. This phrase describes perhaps the single biggest change in suture technology since the introduction of synthetics in the 1970s.

Design/Functionality

Rather than a traditional smooth monofilament or braided thread with a needle swedged on one end, Quill^™ SRS consists of standard suture materials (PGA-PCL [a copolymer of glycolide and e-caprolactone], polydioxanone, nylon, and polypropylene) with tiny barbs cut into the length of the filament in a helical array set facing in opposite directions from the midpoint with a needle on each end. This configuration allows tissues to be re-approximated without surgical knots. The barbs on one end secure the suture in the tissues and are counterbalanced by the opposing barbs on the other end of the suture. In testing performed by the author in both open and laparoscopic cases, the suture functioned exactly as billed. It is amazing!

On the downside, this product was designed by a plastic surgeon, and the selection of needles and the suture lengths are not ideal. In fact, the needles stink. The metal is poor quality and the midportion is flimsy. As a result, they bend easily with torque. Those complaints aside, Quill^™ SRS is slick and easy to use.

Design/Functionality Score: 4.0

Innovation

This technological advancement is huge. The biomechanics of bidirectional barbed suture should lead most surgeons to realize why knots are unnecessary. In fact, if one thinks about the tension on each square millimeter of tissue, it seems likely that barbed suture would more evenly spread the suture-line tension out across the length of the incision, rather than focusing it on the ends, as occurs with traditional sutures and knots.

Innovation Score: 5.0

Value

With a retail price of $239.40 per box of 12 (#1 PDO configured at 14 cm × 14 cm), Quill^™ SRS is comparable with the retail pricing of most other suture material. For open cases, Quill^™ SRS is essentially a wash. For laparoscopic cases, the savings are huge. Even for the best of intra- and extracorporeal knot tiers, there is a big time savings, and time is money. For those who are suture-tying challenged and use devices such as Lapra Ty^™ (Ethicon) or Endo-Stitch^™ (Covidien AG, Mansfield, MA), the savings are even bigger. And for those who use the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) mostly to assist with knot-tying, don’t even ask.

Value Score: 5

Summary

The Quill^™ Self-Retaining System is a brand new product with a very limited clinical track record. Theoretically and in vitro,² it has revolutionary potential as a surgical suture product, but it needs testing in clinical trials. That said, it is US Food and Drug Administration approved as “substantially equivalent” to PDS II synthetic absorbable suture (Ethicon) for the indication of “soft tissue approximation where use of an absorbable suture is appropriate.”³ This is an exciting product.

Overall Score: 4.5

Quill^™ Self-Retaining System (Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada). Reprinted with permission of Angiotech Pharmaceuticals, Inc.