Laparoscopic Modified Richardson Angle Inseam Vaginal Cuff Closure

Abstract

ObjectiveThe Richardson Vaginal cuff closure was first described in 1929 for total abdominal hysterectomy and was widely considered the gold standard cuff closure in such cases for nearly a century (1). We have successfully adopted a modification of this technique for our laparoscopic total hysterectomy.DescriptionLaparoscopic closure of the vaginal cuff was performed by one surgeon, in one hospital, in 141 patients over a two and a half year time period (from January 2012). The Ace Harmonic Scalpel was used for colpotomy and transection of the lower cardinal ligaments in all cases. Monocryl #1 suture was used for closure in all cases. Knots were tied extra-corporally. We have had one documented patient with vaginal cuff dehiscence and no other cuff related complications since adopting this cuff closure technique. The video will detail the the closure technique on a single patient. Key points are the bilateral inversion of the vaginal cuff angles at closure, and the use of interrupted sutures. Speculum inspection of the vagina immediately upon closure reveals a clean, smooth, hemostatic cuff resembling the lateral inseam of a well tailored trouser.ConclusionThe Inseam vaginal cuff closure technique can be performed quite easily by skilled laparoscopic and robotic surgeons and appears to help in the prevention of post-hysterectomy vaginal cuff dehiscence.Reference1.Richardson EH. A simplified technique for abdominal panhysterectomy. Surg Obstet Gynecol 1929;48:248.DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:Barry Schlafstein: ConMed, consultant, Honorarium ObjectiveThe Richardson Vaginal cuff closure was first described in 1929 for total abdominal hysterectomy and was widely considered the gold standard cuff closure in such cases for nearly a century (1). We have successfully adopted a modification of this technique for our laparoscopic total hysterectomy. The Richardson Vaginal cuff closure was first described in 1929 for total abdominal hysterectomy and was widely considered the gold standard cuff closure in such cases for nearly a century (1). We have successfully adopted a modification of this technique for our laparoscopic total hysterectomy. DescriptionLaparoscopic closure of the vaginal cuff was performed by one surgeon, in one hospital, in 141 patients over a two and a half year time period (from January 2012). The Ace Harmonic Scalpel was used for colpotomy and transection of the lower cardinal ligaments in all cases. Monocryl #1 suture was used for closure in all cases. Knots were tied extra-corporally. We have had one documented patient with vaginal cuff dehiscence and no other cuff related complications since adopting this cuff closure technique. The video will detail the the closure technique on a single patient. Key points are the bilateral inversion of the vaginal cuff angles at closure, and the use of interrupted sutures. Speculum inspection of the vagina immediately upon closure reveals a clean, smooth, hemostatic cuff resembling the lateral inseam of a well tailored trouser. Laparoscopic closure of the vaginal cuff was performed by one surgeon, in one hospital, in 141 patients over a two and a half year time period (from January 2012). The Ace Harmonic Scalpel was used for colpotomy and transection of the lower cardinal ligaments in all cases. Monocryl #1 suture was used for closure in all cases. Knots were tied extra-corporally. We have had one documented patient with vaginal cuff dehiscence and no other cuff related complications since adopting this cuff closure technique. The video will detail the the closure technique on a single patient. Key points are the bilateral inversion of the vaginal cuff angles at closure, and the use of interrupted sutures. Speculum inspection of the vagina immediately upon closure reveals a clean, smooth, hemostatic cuff resembling the lateral inseam of a well tailored trouser. ConclusionThe Inseam vaginal cuff closure technique can be performed quite easily by skilled laparoscopic and robotic surgeons and appears to help in the prevention of post-hysterectomy vaginal cuff dehiscence. The Inseam vaginal cuff closure technique can be performed quite easily by skilled laparoscopic and robotic surgeons and appears to help in the prevention of post-hysterectomy vaginal cuff dehiscence.