Abstract
BackgroundThe aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH).MethodsThis two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed.ResultsSeventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230).ConclusionThe MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.
Highlights
The benefits of laparoscopy including less postoperative discomfort, short recovery time, and improved patient outcomes are well documented in the literature [1], there are many factors still limiting the wideKalkan and Bakay BMC Women’s Health (2022) 22:6 acceptance and implementation of the technique for hysterectomy [2]
160 patients who met the inclusion criteria were allocated into two groups by a computer-based randomization programme as standard colpotomy (ST) group and modified Bakay technique (MT) group
Of 80 patients allocated for ST group, 10 patients were dropped out (n = 7 not attending to the visit on Day 90, n = 3 having a diagnosis of deep infiltrating endometriosis requiring discoid vaginal wall resection during total laparoscopic hysterectomy (TLH))
Summary
The benefits of laparoscopy including less postoperative discomfort, short recovery time, and improved patient outcomes are well documented in the literature [1], there are many factors still limiting the wideKalkan and Bakay BMC Women’s Health (2022) 22:6 acceptance and implementation of the technique for hysterectomy [2]. The most challenging steps of total laparoscopic hysterectomy (TLH) are colpotomy and cuff closure. Electrosurgical colpotomy is usually the preferred technique in TLH This may cause more extensive tissue necrosis and devascularization, leading to a thicker inflammatory infiltrate and late tissue healing (i.e., per secundam intentionem). This prolonged inflammatory phase may increase the risk of cuff cellulitis, dehiscence, granulation and secondary haemorrhages. The aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH)
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