Vaginal Cuff Closure with a Figure-of-Eight Suture in Total Laparoscopic Hysterectomy: Outcome from 173 Consecutive...

Area of Science:

• Gynecological Surgery
• Minimally Invasive Procedures
• Surgical Techniques

Background:

• Hysterectomy is a common gynecological procedure, with laparoscopic hysterectomy (TLH) offering superior patient outcomes compared to abdominal approaches.
• Standardization of vaginal cuff closure techniques during TLH is lacking in current international literature.
• The figure-of-eight suture method is proposed as a potentially sufficient, reproducible, time-efficient, and safe technique.

Purpose of the Study:

• To evaluate the efficacy and safety of using a figure-of-eight suture for vaginal cuff closure during total laparoscopic hysterectomy (TLH).
• To demonstrate that this method is reproducible and time-efficient for standardization in TLH.

Main Methods:

• Retrospective observational study of 173 patients undergoing TLH between January 2016 and December 2021.
• Standardized surgical steps included ligation of uterine arteries and broad ligament fenestration.
• Vaginal cuff closure was performed laparoscopically using an absorbable suture in a figure-of-eight pattern, incorporating adjacent structures.

Main Results:

• TLH was successfully completed in all 173 cases without conversion to open surgery.
• The mean operative time was 92 minutes, with a low rate of major complications (e.g., ureteral injury 1.2%, rectosigmoid perforation 0.6%).
• Postoperative complications included vaginal cuff dehiscence (1.2%), fever (3.5%), and vaginal discharge (2.3%), with low rates requiring intervention.

Conclusions:

• Vaginal cuff closure using a figure-of-eight suture during TLH is a sufficient and safe technique.
• The method demonstrated acceptable operative times and a low incidence of postoperative complications.
• This technique is reproducible and can be integrated into standardized total laparoscopic hysterectomy protocols.