title: Vaginal cuff dehiscence in robotic-assisted total hysterectomy.
abstract: OBJECTIVE
  The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence.
  
  
  METHODS
  This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy.
  
  
  RESULTS
  There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk.
  
  
  CONCLUSIONS
  In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature.
authors.affiliation: Department of Obstetrics & Gynecology, Yale New Haven Health, New Haven, CT, USA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Kashani
authors.forename: Taryn
authors.initials: T
authors.lastname: Gallo
authors.forename: Anita
authors.initials: A
authors.lastname: Sargent
authors.forename: Karim
authors.initials: K
authors.lastname: Elsahwi
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
mesh_terms: D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006764:Hospitals, Community; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014621:Vagina / Q000601:surgery*