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Apical Support After Benign Laparoscopic Hysterectomy: A Randomized Controlled Trial Comparing Vaginal Cuff Closure
Kathryn A Edmonds1, Christine M Vaccaro2, Candice E Jones-Cox3
1Minimally Invasive Gynecologic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA. ka.edmonds421@gmail.com.
International Urogynecology Journal
|March 22, 2026
Summary
Comparing laparoscopic versus vaginal cuff closure after hysterectomy, this study found no significant difference in pelvic floor support up to one year. Laparoscopic closure was hypothesized to be superior but results showed similar apical support outcomes.
Area of Science:
- Gynecology
- Minimally Invasive Surgery
- Urogynecology
Background:
- Vaginal cuff closure technique after laparoscopic hysterectomy lacks standardization.
- Pelvic floor support is a critical consideration post-hysterectomy.
Purpose of the Study:
- To compare pelvic floor support between vaginal and laparoscopic cuff closure methods.
- To determine if laparoscopic closure offers superior apical support compared to vaginal closure.
Main Methods:
- Randomized controlled trial involving women undergoing benign total laparoscopic hysterectomy.
- Pelvic Organ Prolapse Quantitation (POPQ) system used to assess apical support preoperatively and at 6-8 weeks and 1 year postoperatively.
- Blinded Urogynecologists performed POPQ exams; patients randomized to vaginal or laparoscopic cuff closure.
Main Results:
- Sample size not met due to COVID-19 pandemic impacting enrollment and retention.
- No significant difference in mean Point C measurements between laparoscopic and vaginal cuff closure at 6-8 weeks (p=0.55) and 1 year (p=0.48).
- No significant differences observed in other POPQ exam points or complication rates between groups.
Conclusions:
- Laparoscopic and vaginal cuff closure yield comparable apical support up to one year post-total laparoscopic hysterectomy.
- Current evidence does not support the hypothesis that laparoscopic closure is superior for pelvic floor support.
