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.
Highlights
BackgroundHysterectomy is one of the most common surgeries performed on women in the United States, with approximately 600,000 performed each year [1,2]
Tsafrir et al experienced no cases of vaginal cuff dehiscence (VCD) in a randomized controlled trial of 90 cases of intracorporeal vaginal cuff closure; their analysis compared a running 2.0 barbed suture, an interrupted 0 Vicryl suture, and a running 0 Vicryl suture with Lapra-Ty [44]
Paek et al reported a longer timeline before surgical proficiency is attained, at about 40 cases [48]. Regardless, these findings suggest that the learning curve is steep for intracorporeal suturing of the vaginal cuff in laparoendoscopic single-site surgery (LESS), it can be overcome with sufficient practice
Summary
Hysterectomy is one of the most common surgeries performed on women in the United States, with approximately 600,000 performed each year [1,2]. The researchers developed a box model (Pelv-Sim) for training residents in several laparoscopic skills specific to gynecologic surgery, including closure of the vaginal cuff, transposition of an ovary to the pelvic side wall, ligation of an infundibulopelvic ligament, and closure of a port-site fascial incision. The literature shows that these materials are non-inferior to traditional sutures, and some studies suggest a modest benefit in postoperative complications and operative duration Despite their high material cost, reduced operating room time may offset the higher price for barbed sutures. We identified only three studies that evaluated different intracorporeal suture techniques of the vaginal cuff in minimally invasive hysterectomy (Table 4) [42,43,44]
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