title: Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy.
abstract: OBJECTIVE
  Vaginal cuff separation is a rare but serious complication following hysterectomy. The goal of our study was to determine the rate of vaginal cuff separation and associated risk factors in patients undergoing laparoscopic or robotic hysterectomy.
  
  
  METHODS
  We retrospectively identified patients who underwent a minimally invasive simple or radical hysterectomy at one institution between January 2000 and 2009. Fisher's exact test, Wilcoxon rank sum test and multiple logistic regression were used to determine associations between variables and increased risk of separation.
  
  
  RESULTS
  A total of 417 patients underwent laparoscopic (n=285) or robotic (n=132) hysterectomy during the study period. Three hundred and sixty-two underwent simple hysterectomy (249 laparoscopic, 113 robotic) and 57 underwent radical hysterectomy (36 laparoscopic, 19 robotic). Seven (1.7%) patients developed a cuff complication and all had a diagnosis of malignancy. Three (1.1%) patients in the laparoscopy group suffered a vaginal cuff evisceration (n=2) or separation (n=1). Four patients in the robotic group (3.0%) had a vaginal evisceration (n=1) or separation (n=3). There was no difference based on surgical approach (p=0.22). Vaginal cuff complications were 9.46-fold higher among patients who had a radical hysterectomy (p<0.01). Median time to presentation of vaginal cuff complication was 128 days (range, 58-175) in the laparoscopy group and 37 days (range, 32-44) in the robotic group.
  
  
  CONCLUSIONS
  The overall risk of vaginal cuff complication was 1.7%. There appears to be no difference in cuff complication rates based on surgical approach. Radical hysterectomy, however, was associated with a 9-fold increase in vaginal cuff complications.
authors.affiliation: Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.forename: Jimena
authors.initials: J
authors.lastname: Lange
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Schlumbrecht
authors.forename: Ricardo
authors.initials: R
authors.lastname: dos Reis
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D014621:Vagina / Q000601:surgery*; D055815:Young Adult