Avoiding vaginal cuff dehiscence after robotic oncological surgery: reliable suturing technique

The rate of vaginal cuff dehiscence seems to have been shown to increase after both robotic and laparoscopic surgeries compared with that after the open approach. The aim of this study was to describe the vaginal cuff dehiscence rate with a novel vaginal suturing technique performed by a robotic approach in the treatment of oncological conditions.

Medical records of all robotic procedures from January 1, 2009, until August 10, 2009, performed at the European Institute of Oncology of Milan were reviewed. Forty vaginal closures were carried out with a novel technique after extrafascial or radical hysterectomy for an oncological diagnosis. Outcomes were compared with those of 41 parallel vaginal closures performed with other techniques.

Among the 40 patients treated with the novel technique, an endometrial pathological feature was observed in 15 (37.5%); ovarian disease, 13 (32.5%); and cervical malignancies, 12 (30%). No vaginal cuff dehiscences were observed after a median follow-up time of 126 days (range, 36-248 days). On the other group, an endometrial pathological feature was observed in 12 patients (29.6%); ovarian disease, 6 (14.6%); cervical malignancies, 22 (53.6%); and tubal cancer, 1 (2.2%). Three vaginal cuff dehiscences were observed after a median follow-up time of 130 days (range, 39-261 days).

The results of the study suggest that vaginal closure technique may decrease the vaginal cuff dehiscence rate for robotic surgery, although longer follow-up time is needed, and larger studies should be carried out, encouraging gynecologic surgeons to perform it.