Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials

Abstract

Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions. The development of minimally invasive surgery has transformed this procedure, resulting in improved outcomes, superior cosmesis, and quicker return to normal function. Vaginal cuff closure is a critical component of hysterectomy, with many variations in surgical technique and materials. This review provides an overview of intracorporeal suturing and knot-tying techniques at the level of a junior resident in obstetrics and gynecology and describes several validated models that have been developed to test resident skill level in vaginal cuff closure. We also provide a review of the literature regarding vaginal cuff closure techniques and suture materials, including knotless barbed sutures. Finally, a brief discussion of single-site surgery, the latest development in minimally invasive hysterectomy, will be provided. We hope to provide a better understanding of vaginal cuff closure for residents in the field of obstetrics and gynecology.

Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy

“…They found that barbed sutures reduced the time for vaginal cuff suturing. In a review, Smith et al [29] also found that barbed sutures decreased the average total procedure time by 15.6 minutes and 5.4 minutes for vaginal cuff suturing. This shortened surgical time may theoretically compensate for the elevated cost of barbed sutures [25].…”

New continuous barbed suture device with stratafix for the vaginal stump in laparoscopic hysterectomy

“…Although there was no report regarding the SF for the vaginal stump, other barbed suture devices have been assessed in some literatures. [ 4 5 6 7 8 9 10 11 12 13 14 ] Besides, almost reported with other barbed suture devices were retrospective analysis. [ 6 12 ] Comparative studies reviewed vaginal stump suture times and operative time and the estimated blood loss was even between barbed sutures and conventional sutures.…”

“…Most current articles are still reviewing the superiority of these techniques. [ 5 ] Some reports estimated the degree of technical difficulty and stated that barbed suture suturing was clearly easier than conventional suturing. [ 4 ]…”

“…Vaginal stump dehiscence is one of the not negligible complications in reported cases, while our duplicated stump closures seem to contribute to the lack of experience in our patients. [ 4 5 7 ] Suture tying technique has many individual variation in vaginal stump closure. SF may bridge the individual variations by operators, and a decrease in the definitive surgical cost including the barbed suture material may be expected by reducing the operating room times.…”

“…The most important considerations regarding the administration of new devices for the vaginal stump closure are operative time, postoperative complications, and cost. [ 5 ] There is still a lack of information concerning the efficacy of SF for intracorporeal vaginal stump suture in minimally invasive hysterectomy. The purpose of this study was to assess the safety and feasibility of SF suturing for TLH in comparison to conventional interrupted suture.…”