title: Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature.
abstract: OBJECTIVE
  To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy.
  
  
  METHODS
  We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used.
  
  
  RESULTS
  In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6).
  
  
  CONCLUSIONS
  Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. stefucc@libero.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery; D014621:Vagina / Q000601:surgery*