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Published on: November 12, 2021
Vaginal versus laparoscopic suture for vaginal cuff closure in total robot-assisted laparoscopic hysterectomy: A
Henri Wohrer1, Sixtine Bernard2, Victor Gaultier1
1Bichat Hospital, Paris, France; University Paris Cité, Paris, France.
Background:
Vaginal cuff closure is an important step in hysterectomy. To date, the literature and data on this procedure are inconsistent, and the optimal approach (i.e., vaginal or laparoscopic) for closing the vagina at the end of laparoscopic robot-assisted hysterectomy remains unclear. Vaginal cuff complications are rare, but their prevention is an important issue.
Objective:
The objective of the present study was to compare early postoperative complications in patients who underwent robot-assisted hysterectomy between the robot-assisted closure group and the transvaginal closure group.
Methods:
In this observational, retrospective, multicentre study, patients who underwent total robot-assisted hysterectomy between January 2016 and March 2021 were included. Two groups (robot-assisted and transvaginal closure groups) were compared in terms of the rate of rehospitalization within the first 30 postoperative days, for all causes and for vaginal scar-related complications.
Results:
Among the 328 patients included, 185 and 143 underwent robot-assisted and transvaginal closure, respectively. Patients in the transvaginal closure group had a significantly greater risk of rehospitalization for all causes (9.8 % vs. 3.2 %; p = 0.02) and for vaginal cuff complications (8.4 % vs. 2.6 %, p = 0.04). According to the univariate analysis, obesity, HIV infection, blood loss > 500 mL and transvaginal closure were associated with a higher incidence of rehospitalization within 30 days. Multivariate analysis revealed that transvaginal closure (p = 0.01) and obesity (p = 0.03) were significantly associated with a greater risk of rehospitalization.
Conclusion:
Compared with transvaginal closure, robot-assisted vaginal closure in robot-assisted total hysterectomy is associated with a reduction in all-cause rehospitalization as well as a reduction in rehospitalization due to vaginal cuff complications. Rates of rehospitalization for vaginal abscess or bleeding could be reduced by avoiding transvaginal closure.
