Electrosurgical Settings and Vaginal Cuff Complications

Abstract

Background and Objectives:After being encouraged to change the technique for opening the vaginal cuff during robotic surgery, this study was performed to determine the correlation between vaginal cuff complications and electrosurgical techniques.Methods:The study group consisted of patients who had their vaginal cuffs opened with a cutting current compared to the group of patients having their vaginal cuff opened with a coagulation current. Data were collected on 150 women who underwent robotic surgery for endometrial cancer. All patients received preoperative antibiotics. Data, including operative time, type of electrosurgery used, estimated blood loss, transfusion rate, and complications, were collected from the patients' records.Results:Surgeries in 150 women and the associated complications were studied. The mean age of the patients was not significantly different between the groups (P = .63). The mean body mass index was 38 kg/m2 in the coagulation arm and 36 kg/m2 in the cutting arm (P = .03). Transfusion was not required. Estimated blood loss and operative time were not significantly different in the coagulation versus the cutting arms (P = .29 and .5; respectively). No patients in the cutting arm and 4 patients (with 5 complications) in the coagulation arm had cuff complications (P = .02).Conclusions:Complications involving the vaginal cuff appear to occur more frequently when the vagina is entered by using electrosurgery with coagulation versus cutting in this cohort of patients undergoing robot-assisted surgery for endometrial cancer..

Introduction of robot‐assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome

“…In agreement with recent publications, we observed considerably less intraoperative complications after RRH but a similar rate of postoperative adverse events compared with ORH The panorama of complications was comparable between the groups with the exception of vaginal cuff dehiscence (five vs. one after RRH and ORH, respectively). Vaginal cuff dehiscence is a well‐known complication after robot‐assisted hysterectomy and is probably caused by excessive use of electrocoagulation and/or incorrect suture technique . Furthermore, significantly more women were readmitted within 30 days in RRH group, mainly because of minor complications including urinary tract infections and lymphatic leakage.…”

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

“…Surgical risks include extensive or inadequate application of electrosurgical technique (e.g. coagulation instead of cutting mode for vaginal incision [ 111 ]), transvaginal closure of the vault, use of single instead of continuous stiches, postoperative infection and supravaginal hematoma [ 106 , 108 ]. Patient-related risks for developing VCD are: premenopausal status, smoking habit, and preexistent endometriosis [ 103 , 105 – 113 ].…”

Vaginal Evisceration After Abdominal Hysterectomy: A Case Report

“…The use of cauterization on the vaginal cuff inflicts additional tissue damage, which affects negatively tissue healing and is considered a major risk factor for the development of VCD [ 2 ]. Therefore it should be avoided during colpotomy and hemostasis, whereas the use of sutures appears to be safer [ 11 , 13 ].…”