Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures.
OBJECTIVE
To estimate the incidence and characteristics of patients with vaginal cuff dehiscence after robotic cuff closure.


METHODS
We reviewed medical records from March 2004 to December 2008 of all patients with vaginal cuff dehiscence after a robotic simple and radical hysterectomy, trachelectomy, and upper vaginectomy using the robotic da Vinci Surgical System.


RESULTS
Twenty-one of 510 patients were identified with vaginal cuff dehiscence (incidence 4.1%, 95% confidence interval 2.3-5.8%). In nine patients, the robotic procedure was performed for a gynecologic malignancy. Coitus was the triggering event in 10 patients. Patients most commonly presented with vaginal bleeding and sudden gush of watery vaginal discharge. Bowel evisceration was associated in six patients. Median time to presentation was 43 days or 6.1 weeks. Nineteen cases were repaired through a vaginal approach and one combined vaginal and laparoscopic. Three of 21 patients experienced a repeat dehiscence and required a second repair.


CONCLUSIONS
Vaginal cuff dehiscence should be considered in patients with vaginal bleeding and sudden watery discharge after robotic cuff closure. The incidence is similar as previously reported for laparoscopic procedures. Contributing factors remain unknown but thermal effect and vaginal closure technique probably play major roles.


METHODS
III.
Kho
Rosanne M
RM
From the Department of Gynecologic Surgery, Mayo Clinic, Scottsdale, Arizona.
Akl
Mohamed N
MN
Cornella
Jeffrey L
JL
Magtibay
Paul M
PM
Wechter
Mary Ellen
ME
Magrina
Javier F
JF
D000328:Adult; D000368:Aged; D003075:Coitus; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012371:Robotics; D013529:Surgical Wound Dehiscence; D013997:Time Factors; D014621:Vagina / Q000601:surgery*; D019522:Vaginal Discharge / Q000209:etiology