Risk factors for vaginal cuff dehiscence after robot-assisted total laparoscopic hysterectomy: A retrospective cohort...

Minimally invasive surgery is preferred over laparotomy due to shorter hospital stays, faster recovery, and reduced risk of complications. Despite these advantages, studies indicate an increased risk of vaginal cuff dehiscence (VCD) after laparoscopic and especially robotic-assisted total hysterectomy (RA-TLH). Over the past decades, the use of laparoscopic and robotic surgery has increased in the Western world, including the Nordic countries. It remains unclear who is at higher risk of VCD. This study aims to identify patient-related and surgical risk factors for VCD following RA-TLH.

A retrospective review of medical records of women who underwent RA-TLH at Trondheim University Hospital, Norway, from 2010 to 2021. Women experiencing VCD were identified and compared to women without VCD. Demographic and surgical data were compared between the groups using univariate and multivariate logistic regression analyses to identify risk factors for VCD.

Out of 1549 eligible women, 684 (44.2%) consented to participate. Twenty-eight women (4.2%) were diagnosed with VCD at a median of 73 days (range 28-278) after surgery. Vaginal intercourse was identified as the triggering event in 23 (82%) women. Younger age, lower BMI, longer surgery duration, and higher uterine weight were associated with an increased risk of VCD in univariate analyses. Multivariate analysis showed that each unit increase in BMI reduced the odds, aOR 0.87 (95% CI 0.78-0.97), whereas each 100 g increase in uterine weight increased the odds, aOR 1.30 (95% CI 1.06-1.60).

VCD occurred in 4.2% of included women. Vaginal intercourse was the most common trigger of VCD. High BMI protected against VCD after RA-TLH. Women with a large uterus had an increased risk of VCD. Our findings underline the importance of preoperative counseling, discussing the advantages and risks of different surgical approaches according to each woman's risk factors.