Vaginal Cuff Closure: Tips for Ipsilateral Port Suturing

Abstract

Video Objective To outline the steps and techniques for laparoscopic vaginal cuff closure with a focus on ipsilateral port suturing. Setting Female with abnormal uterine bleeding who desired definitive management with total laparoscopic hysterectomy. Interventions Laparoscopic vaginal cuff closure following hysterectomy. Conclusion Hysterectomies are one of the most common surgeries performed in the United States each year. Minimally invasive surgery has transformed this procedure with improved outcomes, shorter hospital stays, faster recovery, decreased blood loss, and decreased morbidity when compared to abdominal approach. With laparoscopic hysterectomy, there are multiple techniques for vaginal cuff closure including both laparoscopic and vaginal approaches, often determined by surgeon comfort. In general, data suggests both methods are safe with no significant differences. Within laparoscopic cuff closure, there are various approaches. Intracorporeal suturing remains one of the most challenging laparoscopic tasks. However, it is also an essential skill not just for vaginal cuff closure but a variety of gynecologic minimally invasive surgeries including myomectomies and cystectomies. This video focuses on a laparoscopic suturing approach when two ipsilateral ports are used for cuff closure, which is often more ergonomic for the surgeon. The video highlights proper ergonomics, ipsilateral ports placement, techniques for suture insertion and removal and ipsilateral suture techniques with the goal to improve surgeon knowledge and comfort.