Vaginal Cuff Complications After Closure with an Endoscopic Device versus Conventional Suturing

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Laparoscopic suturing proficiency is critical for total laparoscopic hysterectomy.
• Intracorporeal suturing presents challenges in needle control and tissue handling.
• Endoscopic suturing devices aim to enhance the surgeon's experience.

Purpose of the Study:

• To compare vaginal cuff complication rates between endoscopic device closure and conventional laparoscopic instrument closure.
• To evaluate the safety and efficacy of endoscopic suturing devices in hysterectomy procedures.

Main Methods:

• Retrospective cohort study (2018-2022) of 223 patients undergoing total laparoscopic hysterectomy.
• Vaginal cuff closures were performed using either an endoscopic device (Endo Stitch) or conventional laparoscopic instruments.
• Statistical analyses compared complication rates between the two groups.

Main Results:

• Overall vaginal cuff complications occurred in 13% of patients (29/223).
• A trend towards increased complications was noted with the Endo Stitch device (19.2% vs 11.4%), but not statistically significant (P=.16).
• Significantly higher rates of cuff cellulitis were observed with Endo Stitch closure (8.5% vs 0%, P=.002).

Conclusions:

• No significant difference in composite vaginal cuff complications was found between endoscopic and conventional laparoscopic methods.
• The trend of increased complications and significantly higher cellulitis rates with endoscopic devices requires further study.
• Both methods are considered appropriate, but larger, higher-powered studies are needed to confirm findings.