Vaginal Cuff Closure Techniques Research Articles

Vaginal Transection Versus Vaginal Entry Cuff Closure Technique Following Elective Abdominal Hysterectomy for Benign Lesions - A Prospective Comparative Study

Background: Total abdominal hysterectomy is most common performed gynaecological operation. There is no standard recommendation or guidelines regarding management of vaginal cuff. This study aimed to determine the advantages and disadvantages of vaginal transection versus vaginal entry technique following elective abdominal hysterectomies for benign lesions. Methodology: This is a comparative study involving 180 women undergoing elective hysterectomy in Sparsh hospital, from 10 Jan 2015 to 10 Jan 2020. Patient was randomized to either transactional vaginal or vagina entry technique of cuff closure. In this, we compare Operating time, length of hospital stays, estimated blood loss, post operative discharge. Vaginal length, vaginal cuff infection and granulation after 6 weeks follow up time. A prospective study on all hysterectomies performed by the single senior surgeon at Sparsh hospital in order to eliminate possible differences in surgical techniques and abilities. Result: We found in this study that operating time, blood loss, post operative discharge from vault is less in transection technique of vaginal cuff closure in comparison to vaginal entry technique. Febrile complain is more in vaginal entry cuff group patients. Hospital stay is long in vaginal entry technique patients. There is no difference in post operative vaginal length in both the techniques. Transection technique is easy to perform. Conclusion: Transection cuff closure technique is better than vaginal entry technique.

Apical support after laparoscopic hysterectomy for benign conditions: a randomized controlled trial comparing vaginal cuff closure techniques

Apical support after laparoscopic hysterectomy for benign conditions: a randomized controlled trial comparing vaginal cuff closure techniques

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.

Vertical Vaginal Cuff Closure Technique

<h3>Study Objective</h3> To demonstrate our technique of vertical cuff closure. <h3>Design</h3> Video presentation. <h3>Setting</h3> Academic Medical Center. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Robotic Vertical Vaginal Cuff Closure. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Vertical cuff closure is a reasonable alternative to horizontal cuff closure.

Impact of a Revised Cuff Closure Technique on the Rate of Vaginal Cuff Dehiscence with Endoscopic Hysterectomy

Study Objective To evaluate the outcome of a specific vaginal cuff closure technique at endoscopic hysterectomy to reduce dehiscence. Design Retrospective cohort study. Setting Academic center, Mayo Clinic Phoenix, Arizona. Patients or Participants 434 consecutive patients undergoing endoscopic hysterectomy (363 robotic, 71 laparoscopic) with a revised cuff closure technique. Interventions Continuous vaginal cuff closure using delayed absorbable suture (PDS or V loc) with full thickness bites 5 mm away from the vaginal edge and 5 mm apart. Measurements and Main Results The mean age of the cohort was 51.4 years (SD 12.5) with a mean BMI of 30 kg/m2 (SD 8.1). Most hysterectomies (73%) were for benign conditions- 94.2% were simple hysterectomies and the remainder, 5.8%, were radical or modified radical. Mean estimated blood loss was 93.4 ml (SD 137.7). At a median follow up of 518.2 days (SD 673.7) vaginal cuff dehiscence (VCD) was observed in 0.7% of patients, as compared to our previous VCD rate of 4.1% (p= 0.00732) [1] with a previous cuff closure technique using polyglactin absorbable suture. There was a trend of a higher VCD among patients with a lower BMI (22.8 vs. 30.1 kg/m2, P= 0.066), and of patients receiving chemotherapy (33.3% vs 3.5%, P= 0.024). Conclusion The use of delayed absorbable suture and mass closure technique (5 mm away from the vaginal edge and 5 mm in between sutures) of the vaginal cuff reduced vaginal cuff dehiscence from 4.1% to 0.7%.

The Risk of Vaginal Cuff Dehiscence with Different Suture Types Following Endoscopic Hysterectomy

Study Objective To evaluate the rate of vaginal cuff dehiscence (VCD) after endoscopic hysterectomy using absorbable vs delayed absorbable suture. Design Retrospective cohort study. Setting Academic center, Mayo Clinic Phoenix, Arizona. Patients or Participants 586 consecutive patients undergoing endoscopic hysterectomy (499 robotic, 87 laparoscopic) with a specific cuff closure technique. Interventions Specific vaginal cuff closure technique with delayed absorbable (PDS and V-loc) or absorbable (Vicryl) suture. Measurements and Main Results The mean age was 50.8 years (SD 12.6) with a mean BMI of 30 kg/m2 (SD 8.4). Most patients were premenopausal (59%) and 4.6% were on or had previously received chemotherapy. Of the hysterectomies performed, 75% were for benign indications, 94.5% were simple hysterectomies and 5.5% were radical or modified radical hysterectomies. Mean estimated blood loss was 93.4 ml (SD 137.7ml). Vicryl was used in 152 patients, PDS in 161 patients and V loc in 273 patients. The 3 groups were similar in demographics except for uterine pathology (benign in 80.9% vs. 72.7% vs 73.2% respectively, p= 0.038), median blood loss (115.7 (SD 134.7) vs 87.9 (SD= 90.5) vs 96.9 (SD 161.2) ml respectively, p= 0.034). After a mean follow up period of 586.6 days (SD 725.7), vaginal cuff dehiscence occurred in 1.2% of patients (2.6% Vicryl, 0.6% PDS and 0.7% V loc, p= 0.165). VCD rate with delayed absorbable suture (PDS or V loc) vs absorbable suture (Vicryl), was 0.7% vs. 2.6%, p= 0.058. respectively. Logistic regression analysis revealed younger age and lower BMI are risk factors for VCD (OR: 0.91 95% CI 0.83-0.99 vs OR 0.76, 95% CI 0.61-0.94 respectively). Conclusion Delayed absorbable suture is preferable for vaginal cuff closure at endoscopic hysterectomy as compared to absorbable suture. Risk factors for vaginal cuff dehiscence are younger age and lower BMI.

Protective Maneuver to Avoid Tumor Spillage during Laparoscopic Radical Hysterectomy: Vaginal Cuff Closure

To demonstrate the feasibility of a protective maneuver to avoid tumor exposure during laparoscopic radical hysterectomy. This video illustrates the vaginal cuff closure technique in cervical cancer surgery. The Oncologic Gynecology Department at the University Hospital La Fe. After the Laparoscopic Approach to Cervical Cancer trial [1], the laparoscopic approach to the surgical treatment of cervical cancer has been questioned: laparotomic surgery has been associated with a better cancer outcome. This publication has changed the current approach recommendation for performing radical hysterectomy from minimally invasive surgery to open surgery. There are some theories that might justify these findings. In minimally invasive surgery, the use of a uterine manipulator can condition the spread owing to erosion and friction caused on the tumor, even leading to the perforation of the tumor. In addition, intraperitoneal colpotomy can lead to pelvic peritoneum contamination by the tumor. To close the gap between laparoscopy and laparotomy, some protective maneuvers, such as vaginal cuff closure, have been proposed [2,3]. These strategies aim to reduce the possibility of manipulation or exposure of the tumor to the pelvis during colpotomy in laparoscopic radical hysterectomy. These protective maneuvers have been shown to decrease the relapse rate in retrospective studies [4]. However, prospective trials are needed to elucidate and confirm these findings. In this video, we explain step-by-step the technique of vaginal cuff closure before a radical hysterectomy performance for uterine cervical cancer. First, the nodal status is established by laparoscopic sentinel lymph node dissection and frozen section study. Bilateral pelvic lymphadenectomy is completed according to the size of the tumor. In the case of negative nodal status, the vaginal cuff is closed: Approximately 2 to 3 cm from the tumor (depending on its size), a circumferential incision of the vaginal mucosa is performed, followed by the dissection of the vaginal wall, which should be sufficient to allow a tension-free vaginal closure. The vaginal cuff is then closed with a running suture. A laparoscopic radical hysterectomy is then completed, and the surgical specimen is removed without any manipulation of the tumor. Avoiding manipulation of the tumor during cancer surgery is crucial. A vaginal cuff closure technique appears to be an easy protective maneuver that prevents tumor exposure and manipulation during laparoscopic radical hysterectomy.

Robotic-Assisted Vaginal Cuff Closure Technique and Vaginal Cuff Dehiscence Rates [16H

INTRODUCTION: While the implementation of robotic surgery has improved many postoperative outcomes, an increased rate of vaginal cuff dehiscence (VCD) has been observed in colpotomy closures performed robotically compared to transvaginal or laparoscopic closures. No consensus exists for suture interval or depth of tissue in intracorporal vaginal cuff closure. A study published by O’Hanlan et al. (Minimally Invasive Surgery, 2016) proposes a suture interval and depth of 5 mm. Our study aims to assess if there is any advantage for decreasing postoperative complications with an alternative closure technique. METHODS: This is a descriptive study of post-operative outcomes at our institution that was conducted via a retrospective chart review. Instances of complications including infection, reoperation and VCD rates were recorded for robotic-assisted laparoscopic hysterectomies and trachelectomies performed between 2016-2017. Robotic vaginal cuff closure was performed using V-Loc 90 suture with suture interval and depth of 10 mm. These outcome rates were compared to the complication rates published by O’Hanlan et al. IRB approval was obtained. RESULTS: 160 patients were included in Group 1. An overall complication rate of 11.9% was noted in our study which included infection, VCD, bleeding and re-operation rates. A 2.5% VCD rate was observed with 1.25% of patient’s requiring re-operation. Postoperative infection rate in Group 1 was 3.1%. CONCLUSION: No significant benefit was demonstrated in patients who underwent robotic-assisted vaginal cuff closure with a suture interval and depth of 10 mm compared to previously published data by O’Hanlan et al using a closure interval and depth of 5 mm.

98: Do attending physicians and trainees agree about what happens in the operating room during robot-assisted laparoscopic hysterectomy procedures?

The objective in this study was to determine agreement between attending and trainee surgeons on important aspects of what happened in the operating room during robot-assisted laparoscopic hysterectomy (RALH) procedures, which are essential for teaching and assessment, e.g., case participation for accurate case logs, intraoperative skill assessment for performance evaluation and feedback. Attending and trainee surgeons performing 56 RALH procedures responded to questionnaires postoperatively concerning: 1) who performed each of 11 steps (L/R excise infundibulopelvic ligament, excise utero-ovarian ligament, skeletonize uterine vessel, electrodessicate uterine vessels, dissect bladder, colpotomy or amputate uterus, close vaginal cuff or cervical stump), 2) vaginal cuff closure technique (VCCT) and suture device (SD) used, 3) trainees’ self-assessed skill and attending assessment of trainees’ skill using GEARS, and difficulty of surgery. For bladder dissection, colpotomy, and vaginal cuff closure, we asked what percentage (0%, 25%, 50%, 75%, or 100%) was performed by the trainee. We analyzed agreement between attending and trainee surgeons using Cohen’s kappa for categorical variables and Krippendorff’s alpha (KA) for ordinal variables, as well as Spearman’s correlation (rho). Kappa was greater than 0.6 for 8 surgical steps (kappa = 0.71, 0.62, 0.82, 0.85, 0.71, 0.78, 0.86, 0.86), suggesting strong agreement between attending and trainee surgeons. We observed kappa values of 0.79 and 0.79 for VCCT and SD, indicating strong agreement. There was weak agreement for depth perception and bimanual dexterity criteria of the GEARS scale (rho = 0.21, 0.29 and KA = 0.158, 0.007, respectively). Skill assessments by attending and trainee surgeons on the domains of efficiency, force sensitivity, autonomy, and robotic control exhibited moderate correlation and agreement (rho = 0.468, 0.534, 0.440, 0.495; KA = 0.473, 0.506, 0.412, 0.484, respectively). There was a moderate level of agreement (kappa = 0.484) on estimating difficulty of surgical case. Our findings show that there is imperfect agreement between attending and trainee surgeons even with who performed parts of the procedure, which intuitively, should be unambiguous. They also disagreed on case difficulty and technical skill. This incongruency on critical aspects of what happened in the operating room poses a significant challenge to teach and learn hysterectomy.

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials.

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.

Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: A randomized controlled trial

ObjectiveThis randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. Study designNinety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty® (Arm 3). Patients’ records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding. ResultsThe study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed. ConclusionsThe type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons’ preference and cost effectiveness.

Vaginal cuff closure technique and the risk for infected pelvic hematoma after vaginal hysterectomy

ObjectivesInfected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication. Study designUntil March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010. ResultsWe identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001). ConclusionsA significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.

Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study

ObjectiveTo evaluate sexual function in women before and after vaginal hysterectomy (VH) and to compare the effects of horizontal and vertical vaginal cuff closure on sexual function. Study DesignWomen with uterine prolapse of stage 2 or higher were included to this prospective, randomized study. All patients underwent VH with McCall Culdoplasty and patients were randomized into two groups in terms of the vaginal cuff closure technique employed which is either vertically (group 1, right to left) or horizontally (group 2, anterior to posterior). Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire—12 Short Form was used to assess sexual function before and 6 months after surgery. ResultsA total of 78 women participated, 37 in group 1 and 41 in group 2. Significant improvements in were thus evident in both groups 1 (p=0.000) and 2 (p=0.000) after surgery; no significant between-group differences were evident. Overall, 61 women (78,2%) had improved PISQ-12 scores postoperatively, 11 (14,1%) scored the same pre- and post-operatively, and 6 (7,9%) scored lower postoperatively. Women who reported poorer sexual function postoperatively, or no improvement, had new-onset or worsening dyspareunia and/or incontinence. ConclusionMost women with uterine prolapse of stage 2 or higher who underwent VH with prolapse repair experienced improved sexual lives postoperatively, regardless of the cuff closure technique used. Although VH to treat POP improves anatomical and sexual concerns, surgery per se may have negative effects on sexual function if new-onset or worsening dyspareunia or incontinence develop.

Laparoscopic Modified Richardson Angle Inseam Vaginal Cuff Closure

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.

Effects of Horizontal vs Vertical Vaginal Cuff Closure Techniques on Vagina Length After Vaginal Hysterectomy

Abstract Study Objective To compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy. Design Prospective randomized study (Canadian Task Force classification I). Setting Teaching and research hospital, a tertiary center. Patients Fifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure. Interventions All patients underwent vaginal hysterectomy. Measurements and Main Results Vagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p Conclusion Vertical cuff closure during vaginal hysterectomy seems to preserve vagina length better than does horizontal cuff closure.

Effects of Horizontal vs Vertical Vaginal Cuff Closure Techniques on Vagina Length After Vaginal Hysterectomy: A Prospective Randomized Study

Study ObjectiveTo compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy. DesignProspective randomized study (Canadian Task Force classification I). SettingTeaching and research hospital, a tertiary center. PatientsFifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure. InterventionsAll patients underwent vaginal hysterectomy. Measurements and Main ResultsVagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p < .001). At 6 weeks postoperatively, the vagina was still significantly shorter in the horizontal group (6.55 [0.89] cm vs 7.42 (0.73) cm; p < .001). The mean difference in vagina length before and after surgery was also significantly higher in the horizontal group than in the vertical group (–1.26 [0.12] cm vs 0.49 [0.11] cm; p < .001). ConclusionVertical cuff closure during vaginal hysterectomy seems to preserve vagina length better than does horizontal cuff closure.

Innovations in Minimally Invasive Hysterectomy

Vaginal hysterectomy, when feasible, is the safest and most cost-effective route for hysterectomy, however, when this is not possible, minimally invasive hysterectomy is often the next best option. Laparoscopic hysterectomy has advanced significantly since 1988, when it was first introduced. Continued improvements in instrumentation, energy sources, hemostatic agents, and vaginal cuff closure techniques have expanded the use of minimally invasive hysterectomy. Variations of laparoscopy, specifically laparoendoscopic single-site surgery hysterectomy and robotic-assisted laparoscopic hysterectomy, have further expanded the role of minimally invasive hysterectomy with the goal of decreasing morbidity. As with any evolving technology, well-designed studies are needed to demonstrate safety, efficacy, and cost-effectiveness before wide-spread adoption.

Outcomes of Vaginal Cuff Closure Techniques in Robotic Hysterectomy: A Prospective Randomized Trial

Outcomes of Vaginal Cuff Closure Techniques in Robotic Hysterectomy: A Prospective Randomized Trial

Total Laparoscopic Hysterectomy – Achieving the Best Technique for Vaginal Cuff Closure

Minimally invasive hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: 1) The ability to confidently close the vaginal cuff laparoscopically and 2) The fear of cuff dehiscence. This has resulted in many practitioners closing the cuff vaginally, which increases operating time, or converting to LSH. We have developed a vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy, is easy to learn and master, and has a low rate of complications/cuff dehiscence.

Clinical Applications of Suturing in Parallel and Perpendicular Planes

Laparoscopic suturing is a complex task that requires many hours of practice and experience to perform proficiently. This video will highlight some clinical applications of suturing using parallel and perpendicular planes in a systematic and geometric approach. This video will demontrate vaginal cuff closure techniques using extra-corporeal and intra-corporeal knot tying. We will also present a myomectomy closure with emphasis on intra-corporeal knot tying, running suturing and suture managment as well as a laparoscopic techhnique for a baseball stitch closure.