Vaginal Cuff Suturing Research Articles

The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study.

2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.

Modification of Fundamentals of Laparoscopic Surgery Manual Tasks Simulation Curriculum With the Addition of the Vaginal Cuff Closure Training

Fundamentals of Laparoscopic Surgery (FLS) is a multiple-choice test and a manual skills exam using simulation that Obstetrics and Gynecology (OBGYN) residents must pass to qualify for board certification. There is insufficient validity evidence supporting the use of FLS as a high-stakes exam. This study examines the correlation between OBGYN residents' performance on the FLS manual tasks and simulated vaginal cuff closure. We compared residents' performance on FLS tasks with simulated vaginal cuff suturing on a model. During the first coached simulation session, after completion of training on the standard 5 FLS tasks, residents were coached on vaginal cuff closure using a simulated model placed inside the standard FLS box trainer. At a subsequent session, their performance was scored using the Global Operative Assessment of Laparoscopic Skills Scale (GOALS) and a second task-specific metric, and these scores were compared to their official FLS score. Twenty-nine residents completed the vaginal cuff simulation training between June 2019 and November 2021. Nineteen of the 29 were able to complete the cuff closure with the mean time to completion being 14.5 minutes. We found no correlation between official manual skills FLS scores and vaginal cuff GOALS scores (rho = -0.02, p = 0.90) or cuff closure assessment tool score (rho = -0.015, p = 0.048). There was also no correlation between time to completion for any FLS task and vaginal cuff closure OSAT scores. All residents reported that they found the cuff to be a useful addition to the FLS curriculum. Our study demonstrated that trainee performance on a simulated vaginal cuff closure model did not correlate with official FLS manual tasks skills. This finding adds to the body of evidence disputing the use of FLS as a high-stakes exam to assess laparoscopic skills in gynecology in the relationship with other variables category.

The Influence of Laparoscopic Benign Hysterectomy in Sexual Function

Objectives: Hysterectomy is the most frequent major surgery performed worldwide in women and in recent years most studies include validated instruments to measure sexual quality of life pre and post operatively. The present review assesses sexual function following abdominal hysterectomy for benign pathology, especially in relation to minimally invasive surgery: laparoscopic and robotics according to different considerations. Mechanism: The uterus has traditionally been considered a sexually functioning organ, so uterine removal has been associated with negative outcomes on patients’ sexual function despite limited and controversial evidence. By contrast, reviews conducted in recent years conclude that hysterectomies performed for benign uterine pathology improve patients’ sexual function and quality of life. Findings in brief: Some factors associated with surgery have been specially assessed: the combination of hysterectomy with bilateral oophorectomy in patients with benign pathology can lead to alterations in sexual function and should be restricted only to patients at high risk of ovarian cancer, moreover, there is no current scientific evidence to justify performing a subtotal hysterectomy to preserve or improve sexual quality of life over total hysterectomy. Conclusions: postoperative sexual changes have not been demonstrated to mainly depend on surgical approach, in fact, patients who had sexual concerns prior surgery will continue to present them after hysterectomy despite of the vaginal cuff suture approach.

Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy

(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.

Correcting the Fundamentals of Laparoscopic Surgery “Illusion of Validity” in Laparoscopic Vaginal Cuff Suturing

The "illusion of validity" is a cognitive bias in which the ability to interpret and predict surgical performance accurately is overestimated. To address this bias, we assessed participants comparing fundamentals of laparoscopic surgery (FLS) and non-FLS tasks with cadaveric vaginal cuff suturing to determine the most representative simulation task for laparoscopic vaginal cuff suturing. Validity (Messick framework) study comparing FLS and non-FLS tasks with cadaveric vaginal cuff suturing. Simulation center cadaver laboratory. Obstetrics and gynecology residents (n=21), minimally invasive gynecologic surgery fellows (n=3), gynecologic surgical subspecialists (n=4), general obstetrician/gynecologists (n=10). Tasks included a simulated vaginal cuff (ipsilateral port placement), needle passage through a metal eyelet loop (contralateral and ipsilateral), and intracorporeal knot tying (contralateral and ipsilateral). Simulation task times were compared with the placement of the first cadaveric vaginal cuff suture time, as well as the in-person and blinded Global Operative Assessment of Laparoscopic Skills (GOALS) score ("relations to other variables" validity evidence). Statistical analyses included Spearman's test of correlation (continuous and ordinal variables) or Wilcoxon rank sum test (categoric variables). There was a stronger association with cadaver cuff suturing time for simulated vaginal cuff suturing time (r=0.73, p <.001) compared with FLS intracorporeal contralateral suturing time (r=0.54, p <.001). Additional measures associated with cadaveric performance included subspecialty training (median: 82 vs 185 seconds, p=.002), number of total laparoscopic hysterectomies (r=-0.53, p <.001), number of laparoscopic cuff closures (r=-0.61, p <.001), number of simulated laparoscopic suturing experiences (r=-0.51, p <.001), and eyelet contralateral time (r=0.52, p <.001). Strong agreement between the in-person and blinded GOALS (intraclass correlation coefficient=0.80) supports response process evidence. Correlations of cadaver cuff time with in-person (Spearman's r=-0.84, p <.001) and blinded GOALS (r=-0.76, p <.001) supports relations to other variables evidence CONCLUSION: The weaker correlation between FLS suturing and cadaver cuff suturing compared with a simulated vaginal cuff model may lead to an "illusion of validity" for assessment in gynecology. Since gynecology specific validity evidence has not been well established for FLS, we recommend prioritizing the use of a simulated vaginal cuff suturing assessment in addition to FLS.

Comparing Participant-Reported Confidence during Laparoscopic Vaginal Cuff Suturing after Training with Two Laparoscopic Simulators

Study Objective To determine if participants’ self-reported confidence level with performing a laparoscopic gynecologic surgical task was higher after training with a gynecology-specific laparoscopic trainer. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology (EMIG) or Fundamentals of Laparoscopic Surgery (FLS) – then underwent training on relevant simulation tasks for 2.5 hours (including peg transfer and intracorporeal knot tying). Measurements and Main Results Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were masked then graded using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool by high-volume minimally invasive gynecologic surgeons. Participants were not aware of their GOALS scores. All participants completed a survey at the conclusion of the session, rating their confidence level during each laparoscopic simulation task on a 5-point Likert scale. Confidence scores were compared using two sample t-tests with unequal variances. No statistically significant differences in confidence levels were noted between EMIG and FLS participants: peg transfer (diff=0.03, p=0.88), intracorporeal knot tying (diff=0.15, p=0.55) and vaginal cuff suturing (diff=0.41, p=0.11). Conclusion Neither EMIG participants nor FLS participants had higher self-rated confidence scores for the simulator tasks or the vaginal cuff suturing task with regard to statistical significance. However, when examining the raw data, confidence scores for all three tasks were higher for EMIG participants than FLS participants. These results suggest that EMIG-randomized participants may have felt better prepared to complete a laparoscopic gynecologic surgical task; however, larger studies are needed to demonstrate this conclusively.

Fine Motor Skills Task Experience and Laparoscopic Vaginal Cuff Suturing Performance after Training with Two Laparoscopic Simulators

Study Objective To determine if prior video gaming or fine motor skills task experience was associated with improved performance on a vaginal cuff suturing task following training with two laparoscopic simulators. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology or Fundamentals of Laparoscopic Surgery – then underwent training on relevant simulation tasks for 2.5 hours. Measurements and Main Results Demographic information was collected for all participants, including fine motor skills task and video gaming experience. Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were masked then graded using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool by high-volume minimally invasive gynecologic surgeons. Two sample t-tests with unequal variances were employed to compare GOALS scores. Significant differences were noted in baseline pre-test composite GOALS scores for participants with prior experience playing instruments (diff=2.7, p=0.007), sewing (diff=2.3, p=0.03) and completing artistic tasks (diff=3.05, p=0.01). However, the mean difference between post- and pre-test composite GOALS scores was not different for participants with prior video gaming or fine motor skills task experience. Conclusion Participants with prior fine motor skills task experience performed better at baseline on the pre-test vaginal cuff model. However, after training, these same participants did not perform better when compared to those without prior fine motor task skill experience, regardless of simulation group. These results suggest that prior fine motor skills task experience may not predispose surgically naive learners to improved performance with certain laparoscopic simulation tasks.

Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing in Naïve Learners after Training with Two Different Laparoscopic Simulators

Study Objective To determine if a gynecology-specific laparoscopic simulation trainer better prepares learners to perform a gynecologic surgical task than the current standard laparoscopic simulation trainer. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology (EMIG) or Fundamentals of Laparoscopic Surgery (FLS) – then underwent training on relevant simulation tasks for 2.5 hours. Measurements and Main Results Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were then masked to simulator group and test phase (pre-/post-test). High-volume minimally invasive gynecologic surgeons graded the videos using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool. Composite GOALS scores were compared using two sample t-tests with unequal variances. The mean difference between post- and pre-composite GOALS scores was 6.50 for EMIG and 4.07 for FLS, p=0.34. Differences in individual GOALS domains were compared using Wilcoxon Rank-Sum tests. The mean EMIG post-pre difference was greater for six of eight individual GOALS domains, though all p-values > 0.05. A post-hoc power analysis revealed n=127 per simulation group was needed to obtain p-value=0.05. Conclusion Neither EMIG nor FLS was associated with better performance on the vaginal cuff suturing task with regard to statistical significance. However, when examining the raw data, EMIG-randomized participants had a larger mean difference between post- and pre-test GOALS scores across multiple domains. These results suggest that EMIG may better prepare surgically naive learners to complete a laparoscopic vaginal cuff suturing task; however, larger studies are needed to demonstrate this conclusively.

The Fundamentals of Laparoscopic Suturing (FLS) “Illusion of Validity” in Laparoscopic Vaginal Cuff Suturing. Is There Anything Better?

Study Objective The “illusion of validity” is a cognitive bias in which the ability to interpret and predict surgical performance accurately is overestimated. To address this cognitive bias, and to determine the most representative task for laparoscopic cuff suturing, we assessed participants on simulation tasks and in placement of the first suture in the vaginal cuff of a cadaver. Design Validity (Messick Framework) study comparing FLS and non-FLS tasks to cadaveric vaginal cuff suturing. Setting Simulation center cadaver lab. Patients or Participants Obstetrics and gynecology residents (n=21), fellows (n=3), gynecologic surgical subspecialists (n=4), general obstetrician/gynecologists (n=10). Interventions Tasks included a simulated vaginal cuff (ipsilateral port placement), needle passage through a metal eyelet loop (contralateral and ipsilateral), and intracorporeal knot tying (contralateral and ipsilateral). Times on these tasks were compared to the placement of the first cadaveric vaginal cuff suture time, as well as the in-person and blinded Global Operative Assessment of Laparoscopic Skills (GOALS) score (validity evidence). Statistical analyses included Spearman's test of correlation (continuous and ordinal variables) or Wilcoxon rank sum test (categorical variables). Measurements and Main Results A strong agreement between the in-person and blinded GOALS (ICC=0.80), and strong correlations of cadaver cuff time with in-person (Spearman's r:-0.84,P Conclusion Laparoscopic cadaveric vaginal cuff suturing performance was generally poor among residents and non-subspecialist gynecologists suggesting an “illusion of validity” in current surgical assessments. Since gynecology specific validity evidence has not been established for the FLS intracorporeal suturing task, we recommend prioritizing the use of a simulated-vaginal cuff suturing assessment instead of FLS.

A comparison of novel laparoscopic suturing techniques in single-port surgery

Objective: To compare the vaginal cuff closure times of a newly developed Turkish-made laparoscopic needle holder (TMLNH) and a Yoon Soon (YS) extracorporeal knot tying technique in the closure of the vaginal cuff during single-port laparoscopic hysterectomy.Material and methods: We retrospectively reviewed a total of 60 consecutive patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 30) or a YS extracorporeal knot tying technique (n = 30).Results: The patients’ demographic data, operative results, and complications were analyzed. Operative time and the time required for vaginal cuff suturing were significantly shorter in the TMLNH group than in the YS extracorporeal knot tying group (60.1 ± 3.2 vs. 77.3 ± 6.0 min, p = .001 and 24.5 ± 3.7 vs. 36.3 ± 3.8 min, p = .001, respectively). The intraoperative and postoperative complications were comparable in both groups.Conclusion: The use of TMLNH for vaginal cuff closure in single-port hysterectomy reduced the operative time and the time required for vaginal cuff suturing. However, both TMLNH and YS extracorporeal knot-tying technique may enable the surgeons to overcome the surgical challenges of SPA surgery.

Tips on robotic single-site surgery suture technique: Screwing and clockwise direction suture technique for Robotic single-site surgery

ObjectivesUsing the da Vinci single-site platform, surgeons can perform more minimally invasive surgery. However, surgical challenges exist due to the limitations of single-site instrumental movements. To aid in the performance of successful robotic single-site hysterectomy, a new suturing technique using the current set of limited instruments is introduced in this study. Material & methodsNew vaginal cuff suturing techniques have been used in 55 robotic single-site hysterectomies in our institute over the past 2 years. A needle driver approach utilizing screwing and advancing the needle driver in the correct direction at an increasing angle from the transverse cuff margin with dragging and formation of an adequate loop of thread was used when suturing the vaginal cuff. ResultsUsing the new vaginal suturing techniques, easy and firm vaginal cuff closure with reduced operative time relative to previous hysterectomies was achieved. ConclusionThe new vaginal cuff suturing techniques may convince more surgeons to perform robotic single-site hysterectomies more frequently and with greater ease.

The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy

To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure. A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups. A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P=0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate. Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.

194 - Does 3D Laparoscopy Improve Vaginal Cuff Suture Time? a Randomized Controlled Trial

194 - Does 3D Laparoscopy Improve Vaginal Cuff Suture Time? a Randomized Controlled Trial

Newly Developed Laparoscopic Needle Holder That Facilitates Knot Tying Makes Vaginal Cuff Suturing Easy in Single-Port Laparoscopic Hysterectomy.

To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH). We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed. The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications. The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.

Overcoming the learning curve of single-port total laparoscopic hysterectomy with barbed suture: a single surgeon's initial experience.

IntroductionSingle-port total laparoscopic hysterectomy (TLH) has not been widely used because of its technical difficulty and steep learning curve, especially the laparoscopic suturing of the vaginal stump. Barbed suturing is a new technology that has the potential to greatly facilitate laparoscopic suturing.AimTo compare surgical outcomes and vaginal vault healing between barbed sutures and traditional sutures in the repair of the vaginal vault during single-port TLH.Material and methodsBetween August 2013 and June 2015, we performed single-port TLH in 85 consecutive patients for benign or premalignant gynecological conditions. The first 48 patients underwent single-port TLH with traditional interrupted sutures, and the next 37 patients underwent single-port TLH with absorbable unidirectional knotless barbed sutures for repair of the vaginal vault.ResultsThe patient characteristics (age, body mass index), procedures performed, uterine weight, and uterine disease were similar between the groups. There were no differences in blood loss, hemoglobin change, length of hospital stay, or perioperative complications. Operative time and the time required for vaginal cuff suturing were significantly shorter in the barbed suture group than in the traditional suture group (57.8 ±13.5 vs. 80.1 ±18.7 min, p < 0.001; 5.5 ±1.7 vs. 12.9 ±3.5 min, p < 0.001). Moreover, the use of barbed sutures significantly reduced the incidence of vaginal granulation tissue formation (2.7% vs. 35.4%, p < 0.001).ConclusionsUse of barbed sutures in single-port TLH reduced the operative time, suturing time of the vaginal vault, and formation of vaginal granulation tissue. Barbed suturing may help overcome surgical difficulties and vaginal cuff complications.

Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis.

Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological procedures nowadays. Minimally invasive procedures seem to increase the risk of vaginal cuff dehiscence (VCD). Barbed suture is a new class of suture introduced to aid surgeons during laparoscopic suturing, with the aim to reduce operative time, blood loss, and vaginal dehiscence. We identified all articles that report a series of laparoscopic or robotic-assisted hysterectomy using barbed suture compared to conventional suture for vaginal cuff closure. The main outcome measures were vaginal cuff suturing time, vaginal bleeding, and vaginal dehiscence with or without small bowel evisceration. Suturing time was meta-analyzed as the standardized mean difference, which is the difference in means of two arms divided by pooled standard deviation with 95 % confidence intervals. For vaginal bleeding and dehiscence risk difference were calculated for each study and then meta-analyzed. Fixed models were considered if heterogeneity was low (I (2) < 50 %), otherwise random models were preferred. We show that minor bleeding (RD = 0, 95 % CI 0.03-0.03; p value = 0.907) and VCD (RD = -0.01, 95 % CI 0.02-0.00; p value = 0.119) are comparable in minimally invasive hysterectomy with or without the use of barbed suture. The major bleeding (RD = -0.03; 95 % CI 0.05-0.00; p value = 0.047) appears borderline significant, but the difference between the two types of sutures is not high and the upper limit of 95 % IC is equal to 0 so they were considered comparable. Instead, meta-analysis on vaginal cuff suturing time demonstrates that suturing time is reduced with the use of barbed suture (SMD = -0.96, 95 % CI 1.26-0.70; p value <0.001). Barbed suture is safe and well tolerated as traditional sutures and is associated with reduced operative time of laparoscopic vaginal vault closure.

Design and Validation of a Novel Assessment Tool for Laparoscopic Suturing of the Vaginal Cuff during Hysterectomy

The aim of this study was to design and validate a new assessment tool for laparoscopic vaginal cuff suturing in a box trainer. A primary grading tool was constructed including a novel checklist component and a previously validated global rating scale. A four-step validation process was then undertaken. Face validity was determined by a survey of a panel of experts in the field of minimally invasive gynecologic surgery. Content validity was assessed via analysis of consistency and variability of the experts' ratings, and items were removed or rephrased according to the experts' comments. Overall, five novices and five expert laparoscopic surgeons were videotaped performing suture closure of a latex vaginal cuff model in a box trainer. The videotapes were reviewed by two raters. Discriminate validity, along with interrater and intrarater reliabilities, was assessed by analysis of the video ratings. The Simulation, Training, Research, and Technology Utilization System center at Brigham and Women's Hospital, a tertiary medical center in Boston, MA. The final assessment tool is presented. We have validated an assessment tool for vaginal cuff suturing in a box trainer.

Barbed Suture vs Traditional Suture in Single-Port Total Laparoscopic Hysterectomy

Study ObjectiveTo compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). DesignCase-control study (Canadian Task Force classification II-2). SettingTwo institutions. PatientsOne hundred two patients with benign uterine disease. InterventionsSingle-port TLH using barbed suture (n = 43) or traditional suture (n = 59). Measurements and Main ResultsPatient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5 minutes; p < .001), as well as total operative time (92.0 vs 105.2 minutes; p = .002). Use of barbed suture is less technically demanding than traditional suture (p < .001). ConclusionUse of barbed suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty.

Vaginal cuff closure with absorbable bidirectional barbed suture during total laparoscopic hysterectomy

ObjectiveHysterectomy represents one of the most performed procedures in gynecological surgery. The minimally invasive approach increases patients’ benefits and reduces hospitalization costs. The aim of this study was to demonstrate the efficacy and safety of double barbed suture in vaginal cuff closure during total laparoscopic hysterectomy. Study designA retrospective cohort study of 88 consecutive patients treated with total laparoscopic hysterectomy for benign or precancerous conditions was undertaken from January 2010 to December 2011. Vaginal cuff suture was performed with traditional interrupted suture with polycolic acid (Vicryl™) in 40 patients and with bidirectional barbed device, Quill SRS™, in 48 patients. ResultsNo difference in vaginal cuff dehiscence, major vaginal bleeding or spotting, and infection was evident between the two groups, with significant reduction in operative times for the bidirectional barbed suture group. ConclusionVaginal cuff suture performed with bidirectional barbed QUILL SRS™ is a safe and well-tolerated procedure that reduces operative times.

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.