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Does Laparoscopic Hysterectomy Increase the Risk of Vaginal Cuff Dehiscence? An Analysis of Outcomes from Multiple Academic Centers and a Review of the Literature.

Publication ,  Journal Article
Mikhail, E; Cain, MA; Shah, M; Solnik, MJ; Sobolewski, CJ; Hart, S
Published in: Surg Technol Int
November 2015

Vaginal cuff dehiscence represents a serious, but infrequent complication after hysterectomy, with a reported increased incidence following a laparoscopic approach. Various risk factors have been proposed including laparoscopically placed suture, surgical experience, use of electrosurgery, surgical indication, and obesity. Technical aspects of the procedure itself have also been questioned such as the variable use of monopolar electrosurgery during colpotomy and the suture type or number of layers chosen to reapproximate the vaginal cuff. Nothwithstanding the tendency for cuff dehiscence to occur following laparoscopic approach, there remains a paucity of high-quality data that supports or refutes this finding or clearly defines the mechanism(s) by which this event occurs allowing for the proposal of objective guidelines for reducing risk. Various techniques have been proposed to decrease the risk of vaginal cuff dehiscence during endoscopic hysterectomy, including use of monopolar current on cutting mode, achievement of cuff hemostasis with sutures rather than electrocoagulation, use of a two-layer cuff closure with polydioxanone suture, and use of bidirectional barbed suture for cuff closure. The authors experience at three university-based minimally invasive gynecologic surgery programs showed a low rate of vaginal cuff dehiscence in their own practices. Large randomized controlled trials are needed to truly determine whether there is a difference in vaginal cuff dehiscence between surgical modalities for hysterectomy as well as to determine the true risk factors.

Duke Scholars

Published In

Surg Technol Int

ISSN

1090-3941

Publication Date

November 2015

Volume

27

Start / End Page

157 / 162

Location

United States

Related Subject Headings

  • Vagina
  • Surgical Wound Dehiscence
  • Risk Factors
  • Laparoscopy
  • Hysterectomy
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mikhail, E., Cain, M. A., Shah, M., Solnik, M. J., Sobolewski, C. J., & Hart, S. (2015). Does Laparoscopic Hysterectomy Increase the Risk of Vaginal Cuff Dehiscence? An Analysis of Outcomes from Multiple Academic Centers and a Review of the Literature. Surg Technol Int, 27, 157–162.
Mikhail, Emad, Mary Ashley Cain, Madhvi Shah, M Jonathon Solnik, Craig J. Sobolewski, and Stuart Hart. “Does Laparoscopic Hysterectomy Increase the Risk of Vaginal Cuff Dehiscence? An Analysis of Outcomes from Multiple Academic Centers and a Review of the Literature.Surg Technol Int 27 (November 2015): 157–62.

Published In

Surg Technol Int

ISSN

1090-3941

Publication Date

November 2015

Volume

27

Start / End Page

157 / 162

Location

United States

Related Subject Headings

  • Vagina
  • Surgical Wound Dehiscence
  • Risk Factors
  • Laparoscopy
  • Hysterectomy
  • Humans
  • Female