“Does a Two-Layer Vaginal Cuff Closure at the Time of Laparoscopic Hysterectomy Reduce Complications Vs. a One-Layer Closure?”

Abstract

Study Objective This video reviews findings from our retrospective cohort study demonstrating that a two-layer vaginal cuff closure (2-LVC) decreases postoperative complications compared to a standard one-layer vaginal cuff closure (1-LVC) at time of time total laparoscopic hysterectomy (TLH). The 2-LVC technique is demonstrated in a stepwise approach. Design Results from our retrospective cohort study analyzing all postoperative complications within 30 days and vaginal cuff complications within 180 days of TLH are reviewed. The two-layer closure technique is demonstrated with narrated footage. Setting A single tertiary care center. Patients or Participants All women undergoing TLH for benign indications by Minimally Invasive Gynecology surgeons from 2011-2017. Interventions 1-LVC and 2-LVC at time of TLH are compared. Surgeon skill, colpotomy technique and suture material remained standardized. The 2-LVC technique is demonstrated with reapproximation of the vaginal mucosa followed by imbrication of the endopelvic fascia. Measurements and Main Results Of 2973 women who underwent TLH for benign indications, 40.8% (n= 1213) of vaginal cuffs were closed with 2-LVC and 59.2% (n=1760) with 1-LVC. There was no difference in intraoperative complications between groups. There were significantly less postoperative complications in the 2-LVC, due to the difference in cuff complications. No mucosal separations or cuff dehiscence in the 2-LVC occurred as compared to 16 cases in the 1-LVC. Conclusion 2-LVC significantly reduces total postoperative complications by lowering vaginal cuff complications and reducing the rate of vaginal cuff dehiscence. Although a rare event, the prevention of vaginal cuff dehiscence by adapting a two-layer vaginal cuff closure, as demonstrated in this video, into routine TLH practice patterns could notably diminish patient morbidity and health care cost. This video reviews findings from our retrospective cohort study demonstrating that a two-layer vaginal cuff closure (2-LVC) decreases postoperative complications compared to a standard one-layer vaginal cuff closure (1-LVC) at time of time total laparoscopic hysterectomy (TLH). The 2-LVC technique is demonstrated in a stepwise approach. Results from our retrospective cohort study analyzing all postoperative complications within 30 days and vaginal cuff complications within 180 days of TLH are reviewed. The two-layer closure technique is demonstrated with narrated footage. A single tertiary care center. All women undergoing TLH for benign indications by Minimally Invasive Gynecology surgeons from 2011-2017. 1-LVC and 2-LVC at time of TLH are compared. Surgeon skill, colpotomy technique and suture material remained standardized. The 2-LVC technique is demonstrated with reapproximation of the vaginal mucosa followed by imbrication of the endopelvic fascia. Of 2973 women who underwent TLH for benign indications, 40.8% (n= 1213) of vaginal cuffs were closed with 2-LVC and 59.2% (n=1760) with 1-LVC. There was no difference in intraoperative complications between groups. There were significantly less postoperative complications in the 2-LVC, due to the difference in cuff complications. No mucosal separations or cuff dehiscence in the 2-LVC occurred as compared to 16 cases in the 1-LVC. 2-LVC significantly reduces total postoperative complications by lowering vaginal cuff complications and reducing the rate of vaginal cuff dehiscence. Although a rare event, the prevention of vaginal cuff dehiscence by adapting a two-layer vaginal cuff closure, as demonstrated in this video, into routine TLH practice patterns could notably diminish patient morbidity and health care cost.