Incidence Of Vaginal Cuff Dehiscence Research Articles

Clinical Relevance of Vaginal Cuff Dehiscence after Minimally Invasive versus Open Hysterectomy.

This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7-1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51-4.98 and OR: 2.20; 95% CI, 1.09-4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence.

Vaginal Cuff Dehiscence: Tips for Laparoscopic Repair and Prevention

<h3>Study Objective</h3> To define vaginal cuff dehiscence, identify risk factors for dehiscence, understand steps needed for laparoscopic cuff revision, and review techniques for cuff closure. <h3>Design</h3> Vaginal cuff dehiscence, defined as a full thickness separation of the vaginal cuff, is a rare but morbid complication after hysterectomy. After a total laparoscopic hysterectomy, the incidence of vaginal cuff dehiscence is 0.7% (range 0.64 – 1.27%). Risk factors include poor vaginal cuff closure technique, smoking, low body mass index, conditions that cause poor wound healing such as infection, hematoma, prior radiation, or immunosuppression, and increased pressure on the vaginal incision line such as trauma, pelvic organ prolapse, or excessive valsalva. In this video we will demonstrate a laparoscopic repair of a vaginal cuff dehiscence. <h3>Setting</h3> Patients should be positioned in lithotomy position in the operating room. Standard GYN laparoscopic setup should be used. The authors prefer placing the camera via a 5mm trocar in the umbilicus, with 2 accessory 5mm ports laterally and a 5mm suprapubic port. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> In this video we describe the 5 steps of a laparoscopic repair of a vaginal cuff dehiscence. We also discuss tips and tricks to optimize cuff closure. • Identify and normalize anatomy • Identify the vaginal cuff defect • Mobilize the cuff • Excise cuff edges • Close the cuff <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Although vaginal cuff dehiscence is rare, knowledge of safe and effective laparoscopic repair technique is crucial for the gynecologic surgeon, both for repair and for prevention of future cuff dehiscence.

Trends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectomy

The primary objective was to assess the effect of the route of closure of the vaginal cuff on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy (LH). The secondary objective was to assess patient- and surgical-risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications. Retrospective chart review with case-control component. Tertiary care center (main hospital and regional hospitals). A total of 1278 women underwent LH or robot-assisted hysterectomy in 2016, and met the inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016. A retrospective comparison of patients with vaginal cuff closure and laparoscopic cuff closure (LCC) undergoing LH or robot-assisted hysterectomy in 2016. Patients with VCD from 2009 through 2016 (n = 26) were matched by route of cuff closure to the next 7 patients who underwent hysterectomies (n = 182), who became controls. In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC (8/989; 0.81%) and vaginal cuff closure (1/289; 0.35%; p = .41). Seven VCD cases were performed by high-volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in the rates of perioperative complications or surgeon volume between routes of cuff closure. The case-control patients differed in smoking status (p = .010) and history of prior laparotomy (p = .017). Logistic regression showed that increasing age (odds ratio 0.95; 95% confidence interval, 0.91-0.99) and increasing body mass index (odds ratio 0.98; 95% confidence interval, 0.83-0.97) were protective for VCD. VCD is a rare but serious complication of LH. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend that, to optimize patient outcomes, surgeons employ the closure technique that they are best accustomed to.

Trends and Risk Factors for Vaginal Cuff Dehiscence After Laparoscopic Hysterectomy

Study Objective Primary objective: Assess the effect of the route of vaginal cuff closure on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy. Secondary objectives: Assess patient and surgical risk factors associated with VCD, the rate of intra- and perioperative complications by route of closure, and the impact of surgeon volume on complications. Design Retrospective chart review with case-control component. Setting Tertiary care referral center. Patients or Participants 1277 women underwent laparoscopic (LH) or robotic-assisted (RAH) hysterectomy in 2016 and met inclusion criteria. 26 cases of VCD were identified from 2009 through 2016. Interventions A retrospective comparison of patients with vaginal (VCC) and laparoscopic (LCC) cuff closure undergoing LH and RAH in 2016. Patients with VCD (n=26) were matched by route of cuff closure to the next seven hysterectomies (n=182) which became controls. Measurements and Main Results In 2016, there were 8 cases of VCD (0.63%). There was no difference between LCC=7/988 (0.71%) and VCC 1/289 (0.35%, p=0.49). 7 VCD cases were performed by high volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture (p<0.001). However, there were no significant differences in rates of perioperative complications or surgeon volume between routes of cuff closure. Case-control patients differed in smoking status (p=0.010) and history of prior laparotomy (p=0.017). Logistic regression showed increasing age (OR 0.95, CI 0.91-0.99) and increasing BMI (OR 0.98, CI 0.83-0.97) were protective for VCD. Conclusion VCD is a rare but serious complication of laparoscopic hysterectomy. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend surgeons employ the closure technique they are best accustomed with to optimize patient outcomes. Primary objective: Assess the effect of the route of vaginal cuff closure on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy. Secondary objectives: Assess patient and surgical risk factors associated with VCD, the rate of intra- and perioperative complications by route of closure, and the impact of surgeon volume on complications. Retrospective chart review with case-control component. Tertiary care referral center. 1277 women underwent laparoscopic (LH) or robotic-assisted (RAH) hysterectomy in 2016 and met inclusion criteria. 26 cases of VCD were identified from 2009 through 2016. A retrospective comparison of patients with vaginal (VCC) and laparoscopic (LCC) cuff closure undergoing LH and RAH in 2016. Patients with VCD (n=26) were matched by route of cuff closure to the next seven hysterectomies (n=182) which became controls. In 2016, there were 8 cases of VCD (0.63%). There was no difference between LCC=7/988 (0.71%) and VCC 1/289 (0.35%, p=0.49). 7 VCD cases were performed by high volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture (p<0.001). However, there were no significant differences in rates of perioperative complications or surgeon volume between routes of cuff closure. Case-control patients differed in smoking status (p=0.010) and history of prior laparotomy (p=0.017). Logistic regression showed increasing age (OR 0.95, CI 0.91-0.99) and increasing BMI (OR 0.98, CI 0.83-0.97) were protective for VCD. VCD is a rare but serious complication of laparoscopic hysterectomy. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend surgeons employ the closure technique they are best accustomed with to optimize patient outcomes.

Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy.

Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal. A total of 13645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH. Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n=15) occurred after TLH (n=1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n=2853), vaginal (n=4150), and abdominal (n=5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P<0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies. Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence.

Reduction of Vaginal Cuff Dehiscence in Total Laparoscopic Hysterectomy with use of Un-barbed Monofilament Suture [5R

INTRODUCTION: The incidence of vaginal cuff dehiscence is higher following total laparoscopic hysterectomy (TLH) compared to vaginal and abdominal hysterectomy. Theorized factors include energy, anatomy, stitch size, and other variables. Following a rise in our dehiscence rate to above 2%, several of our surgeons switched to PDS instead of barbed suture based on clinical observations. We present the results below. METHODS: Vaginal cuff handling at laparoscopic hysterectomy was reconsidered. Our group performs a significant volume of relatively homogeneous TLHs. Several physicians transitioned away from a two way barbed suture closure instead using two way running #1 polydioxanone monofilament suture (#1PDS). PDS closure was performed tensioning as in abdominal or vaginal hysterectomy cuff closure. During a 6 month period the two rates of vaginal cuff separation/dehiscence following TLH were compared using the Chi-squared test. RESULTS: 334 TLHs were included in our 6-month study. No eviscerations were noted. Separations (managed surgically or expectantly) were observed in nine out of 175 cases (9/175, 5.1%) when barbed suture was used vs zero of 159 cases when PDS suture was used (0/159, 0%, p-value .0000028). CONCLUSION: Etiology of observed associations of dehiscence with TLH remains unclear. Postulated solutions include optimization of amputation and cuff closure. Our data show that, in a large multispecialty gynecologic group performing high volume TLHs, dehiscence rate is reduced using PDS monofilament. Techniques employed strive to mimic abdominal hysterectomy cuff closure tension and anatomic stitch bite sizes. This study is limited by cuff closure techniques being performed by different physicians.

Dramatically reduced incidence of vaginal cuff dehiscence in gynecologic patients undergoing endoscopic closure with barbed sutures: A retrospective cohort study

IntroductionThis retrospective study documented the rate of vaginal cuff dehiscence (VCD) in a large series of gynecologic patients who were treated with an endoscopic (robotic-assisted or laparoscopic) hysterectomy that incorporated either delayed absorbable monofilament barbed or vicryl running sutures. MethodWe sought to discern any prognostic associations between operative variables (e.g., closure type (barbed or vicryl sutures), endoscopic approach (robotic-assisted or laparoscopic), and energy source (Harmonic Ace Shears or monopolar/bipolar electro-surgery)) and the risk for VCD via patient chart review. Statistical evaluation was comprised of univariate analyses and multiple regression. ResultsWe identified 1876 subjects; there were 14 cases (0% with barbed suture and 0.99% with vicryl suture) of VCD (an overall incidence of 0.75%), nearly all of which were associated with a robotic-assisted hysterectomy involving vicryl sutures (p = 0.034). However, the type of endoscopic surgery (P = 0.11) and energy source (P = 0.28) were not significant prognostic factors. The VCD patients' exhibited a median duration of 47 days (range, 14–116) until the development of their condition. ConclusionVaginal cuff separation subsequent to laparoscopic closure is a rare occurrence. While our incidence of VCD was low and comparable to other reported rates in the literature, we did not observe any cases of VCD following laparoscopic hysterectomy performed with barbed suture closure.

Incidence of and Risk Factors for Vaginal Cuff Dehiscence After Hysterectomy: A 10-Year Retrospective Case Control Study at Two Institutions

Abstract Objective: The goal of this research was to determine the incidence of vaginal cuff dehiscence after all types of total hysterectomies and to identify potential risk factors for dehiscence. Design: A retrospective chart review was performed to identify the incidence of vaginal cuff dehiscence after hysterectomy. This review was followed by a case-control study to identify risk factors for dehiscence (Canadian Task Force classification II-2). Materials and Methods: A retrospective chart review was performed on all women, at two institutions, who experienced vaginal cuff dehiscence after total hysterectomy over a 10-year period. All patients who experienced cuff dehiscence after any type of hysterectomy were included to determine the incidence of vaginal cuff dehiscence. A case-control study was then performed to identify risk factors for dehiscence. Results: Between 2000 and 2010 there were 4235 total hysterectomies performed and 8 dehiscences giving an overall incidence of vaginal cuff dehiscence...

Comparison of the Incidence of Vaginal Cuff Dehiscence with Laparoscopic Continuous Unidirectional Barbed Suture Closure Versus Interrupted Polyglactin Closure

Comparison of the Incidence of Vaginal Cuff Dehiscence with Laparoscopic Continuous Unidirectional Barbed Suture Closure Versus Interrupted Polyglactin Closure

Modified approach to vaginal hysterectomy without initial colpotomy

To evaluate the surgical technique and outcomes of women undergoing the modified approach to vaginal hysterectomy at Harbor-University of California, Los Angeles Medical Center from 2000 to 2011. A retrospective chart review was performed of all vaginal hysterectomy cases performed using the modified technique. There is much evidence in favor of the safety of vaginal hysterectomy over other modes of hysterectomy, such as the lower overall incidence of vaginal cuff dehiscence, shorter hospital stays and faster recovery from surgery. The traditional method of performing vaginal hysterectomy involves early anterior or posterior colpotomy. At times, this may be difficult secondary to a flush cervix, distorted anatomy, and adhesions from prior surgeries or infection. At our teaching institution, however, we have adopted a different technique, initially developed by Dr. Reza Mohajer who is one of our faculty members and co-author of this article, that facilitates ligation of uterine vessels without initial attempt at colpotomy. This enables Ob/Gyn residents to safely and successfully perform vaginal hysterectomies despite large uterine size, nulliparity, flush cervix and previous pelvic surgery. Modified approach to difficult vaginal hysterectomy facilitates performance of vaginal hysterectomy without need for initial anterior or posterior colpotomy.

Tunneling nanotubes and intercellular communication: a novel approach to chemo-resistance in ovarian cancer

RESULTS: Sixty-five hysterectomy specimens were examined for depth of thermal spread. There was no difference in mean depth of thermal spread at the anterior (1.11 mm vs 1.05 mm; p1⁄40.6) or posterior margin (1.04 mm vs 0.91 mm; p1⁄40.2) between standard energy and V mode , respectively. There was no difference in incidence of vaginal cuff dehiscence (p1⁄40.31), with one dehiscence in the standard group. Rate of vaginal cuff granulation tissue, dehiscence or infection was 24% overall, with no difference between groups.

FBxW7 as a predictor of outcomes in ovarian cancer

RESULTS: Sixty-five hysterectomy specimens were examined for depth of thermal spread. There was no difference in mean depth of thermal spread at the anterior (1.11 mm vs 1.05 mm; p1⁄40.6) or posterior margin (1.04 mm vs 0.91 mm; p1⁄40.2) between standard energy and V mode , respectively. There was no difference in incidence of vaginal cuff dehiscence (p1⁄40.31), with one dehiscence in the standard group. Rate of vaginal cuff granulation tissue, dehiscence or infection was 24% overall, with no difference between groups.

Vaginal cuff dehiscence after hysterectomy

ObjectiveTo determine the incidence of vaginal cuff dehiscence (VCD) among women undergoing hysterectomy according to clinico-surgical factors including surgical route, and to describe patient characteristics associated with VCD. MethodsIn a retrospective study, the medical records of all women who underwent hysterectomy between January 2005 and March 2011 at a university teaching hospital in Seoul, Republic of Korea, were reviewed. The incidence of VCD was determined in relation to the following factors: patient age, hysterectomy route, indication for hysterectomy, and extent of resection (either simple or radical hysterectomy). ResultsAmong 9973 hysterectomies, 37 (0.37%) cases of VCD were identified. The incidence of VCD was significantly higher after abdominal hysterectomy (0.6%) than after laparoscopic (0.2%) or vaginal (0.4%) hysterectomy (P=0.016). Compared with laparoscopic approaches, abdominal hysterectomy was associated with a higher risk of VCD (odds ratio, 2.735; 95% confidence interval, 1.380–5.420). However, there was no significant difference in the incidence of VCD according to surgical indication or extent of resection. ConclusionLaparoscopic hysterectomy was found to be associated with a lower risk of VCD compared with abdominal hysterectomy. The lower risk is probably related to the different techniques used for colpotomy and cuff closure.

Vaginal cuff dehiscence associated with laparoscopic hysterectomy

To the editors: I would like to congratulate Dr Blikkendaal and colleagues for their article on the incidence of vaginal cuff dehiscence (VCD) associated with laparoscopic hysterectomy [1]. VCD is a potentially severe adverse event occurring in between 1 and 3 % of patients following a laparoscopic hysterectomy. Risk factors for VCD are largely unknown. The authors analyze their series of 331 total laparoscopic hysterectomy cases. Vaginal vault closure was achieved transvaginally, laparoscopically interrupted, and with a laparoscopic running suture. The authors conclude that a total of eight VCDs occurred without an association between baseline patient, surgical factors, or the suture technique with the incidents of VCD. We also observed a couple of VCDs using the V-Loc barbed suture [2]. Both patients had a total laparoscopic hysterectomy for prophylactic reasons. Surgery was uncomplicated, and blood loss was minimal. VCD occurred after 2 and 4 months, respectively. The common factor in both patients was a history of breast cancer and chemotherapy. Using identical surgical and suturing technique, it may well be that patient characteristics such as a history of previous chemotherapy rather than suture technique and material will impact on the risk of VCD. Due to the low incidence of VCD, large perspective randomized trials may be infeasible. However, and very concerning, governing bodies approve sutures and other surgical devices, such as meshes, without prior clinical testing. Not a single prospective evaluation of the V-Loc barbed suture is available in a PubMed literature search (PubMed 2000 till 2013). As an alternative, outcomes of surgery using novel devices should be recorded prospectively within a clinical trial setting prior to accreditation and registration. At least nonrandomized data that inform about incidence rates should be made available to surgeons prior to using those devices on live patients. In addition, surgeons should be aware about the outcomes from their surgery. Audit tools will assist to provide feedback and comparative outcomes from peers for benchmarking [3].

Vaginal Cuff Dehiscence after Minimal Invasive Hysterectomy: Laparoscopic Surgical Techniques

Vaginal cuff dehiscence (VCD) after hysterectomy is an adverse event with potential severe morbidity. Although the data are limited, minimally invasive approaches to hysterectomy, such as total laparoscopic hysterectomy (TLH), may be associated with a higher risk of vaginal cuff dehiscence. The cause for these dehiscences is unknown, and multiple factors may be involved. Internationally, the etiology of VCD is still a matter of concern. Either in its technique (TLH) as in the used technology (electrosurgical colpotomy and/or suturing method), an explanation could be found for the higher incidence of VCD. This study aims to review laparoscopic surgical techniques in the minimal invasive hysterectomy and its association with VCD.

Incidence of and Risk Factors for Vaginal Cuff Dehiscence after Hysterectomy: A 10-Year Retrospective Study at Two Institutions

Abstract Objective: The goal of this research was to determine the incidence of vaginal cuff dehiscence after all types of total hysterectomies and to identify potential risk factors for dehiscence. Design: A retrospective chart review was performed to identify the incidence of vaginal cuff dehiscence after hysterectomy. This review was followed by a case-control study to identify risk factors for dehiscence (Canadian Task Force classification II-2). Materials and Methods: A retrospective chart review was performed on all women, at two institutions, who experienced vaginal cuff dehiscence after total hysterectomy over a 10-year period. All patients who experienced cuff dehiscence after any type of hysterectomy were included to determine the incidence of vaginal cuff dehiscence. A case-control study was then performed to identify risk factors for dehiscence. Results: Between 2000 and 2010 there were 4235 total hysterectomies performed and 8 dehiscences giving an overall incidence of vaginal cuff dehiscence...

Incidence of Vaginal Cuff Dehiscence and Urinary Tract Injury after Total Laparoscopic Hysterectomy

The goal of this study is to evaluate total laparoscopic hysterectomy (traditional and robotic) procedures, performed in three university centers with advanced gynecologic laparoscopic programs, to describe the prevalence of post-operative vaginal cuff dehiscence and urinary tract injury. Estimated blood loss and bowel injury were assessed as secondary outcomes.

Decreasing the Incidence of Vaginal Cuff Dehiscence after Total Laparoscopic Hysterectomy Using a Novel Surgical Technique

Decreasing the Incidence of Vaginal Cuff Dehiscence after Total Laparoscopic Hysterectomy Using a Novel Surgical Technique

Vaginal Cuff Dehiscence in Robotic-Assisted Total Hysterectomy

The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy. There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk. In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature.

Vaginal Cuff Dehiscence After Different Modes of Hysterectomy

To update the incidence of vaginal cuff dehiscence after different modes of hysterectomy and to describe surgical and patient characteristics of dehiscence complications. This was an observational cohort study at a large academic hospital. All women who underwent hysterectomy and dehiscence repair between January 2006 and December 2009 were identified. Data from this study period were analyzed separately and in combination with our preliminary study (January 2000 to December 2005) for a 10-year analysis (January 2000 to December 2009). The primary outcome was incidence of vaginal cuff dehiscence after total laparoscopic hysterectomy compared with abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy (LAVH). Between 2006 and 2009, the overall incidence of dehiscence was 0.39% (95% confidence interval [CI] 0.21-0.56). The incidence after total laparoscopic hysterectomy was 0.75% (95% CI 0.09-1.4), which was the highest among all modes of hysterectomy (LAVH was 0.46% [95% CI 0.0-1.10]; total abdominal hysterectomy was 0.38% [95% CI 0.16-0.61]; and total vaginal hysterectomy was 0.11%, [95% CI 0.0-0.32]). This incidence was appreciably lower than previously reported (4.93% in 2007 publication, 2.76% readjusted calculation). The 10-year cumulative incidence of dehiscence after all modes of hysterectomy was 0.24% (95% CI 0.15-0.33) and 1.35% (95% CI 0.72-2.3) among total laparoscopic hysterectomies. During the 10-year study period, total laparoscopic hysterectomy-related dehiscence was significantly increased compared with other modes of hysterectomy, with a risk ratio of dehiscence after total laparoscopic hysterectomy of 9.1 (95% CI 4.1-20.3) compared with total abdominal hysterectomy, risk ratio of 17.2 (95% CI 3.9-75.9) compared with total vaginal hysterectomy, and risk ratio of 4.9 (95% CI 1.1-21.5) compared with LAVH. Our updated 1.35% incidence of dehiscence after total laparoscopic hysterectomy is much lower than previously reported. II.