Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature

Vaginal Cuff Dehiscence; Risk Factors and Associated Morbidities

“…4,5,10 Both laparoscopic and, in particular, robotic-assisted laparoscopic hysterectomies were associated with higher odds of dehiscence. These findings correlate with the available literature 1,12,13 and may reflect the accumulation of more experience with laparoscopic hysterectomy than with robotic-assisted hysterectomy at our institution. As previously reported, an improvement in the experience of surgeons can help in reducing the incidence of cuff separation.…”

“…As previously reported, an improvement in the experience of surgeons can help in reducing the incidence of cuff separation. 1,4,12 We found that women with dehiscence were younger than the general cohort. All other baseline characteristics were similar between groups, including the indication for hysterectomy.…”

“…The latter is in contrast to a previous study that found that when the indication was a malignancy, the risk of dehiscence increased 3-fold. 12 There is inconsistency in the literature regarding baseline characteristics associated with cuff dehiscence; some studies showed younger age to be a risk factor, 2 some cited older age as a risk factor, 14 and some did not find any significant association between age and dehiscence. 5,13 Other baseline characteristics have been sporadically studied.…”

“…[5][6][7][8][9] Limited data exist about the effect of different approaches to colpotomy creation, suture materials, 2 or suturing techniques 10,11 on the risk of vaginal cuff separation. 12 Furthermore, the available retrospective reports often lack clear descriptions of the technique of colpotomy used, especially in abdominal and vaginal hysterectomies. 3 In a literature review by Uccella et al, 12 the pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic and robotic closure (0.64% and 1.64%, respectively).…”

“…Proposed factors unique to minimally invasive procedures that could play a role in this observed difference are a magnified view that could induce the surgeon to include an insufficient amount of tissue in closure and insufficient tension maintained on the suture by traditional laparoscopic or robotic instruments rather than by the surgeon's hands. 12 The aim of this study is to assess whether various sources of energy, suture materials, and surgical techniques applied during hysterectomy via different routes influence the incidence of vaginal cuff dehiscence.…”