title: Vaginal vault dehiscence after robotic hysterectomy for gynecologic cancers: search for risk factors and literature review.
abstract: BACKGROUND
  Vaginal vault dehiscence following robotic-assisted hysterectomy for gynecologic cancer may be attributed to surgical techniques and postoperative therapeutic interventions. We searched for risk factors in patients with gynecologic cancers and complemented this with a literature review.
  
  
  METHODS
  Evaluation of prospectively gathered information on all consecutive robotic surgeries for gynecologic cancers was performed in a tertiary academic cancer center between December 2007 and March 2012. The literature was reviewed for articles relevant to "gynecologic oncology" and "robotics" with "vaginal cuff dehiscence" in the English and French languages. Respective authors were contacted to complete relevant information.
  
  
  RESULTS
  Seven dehiscences were identified of 441 cases with established gynecologic cancers. The closures in these 7 were performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%), combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156, 1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk factors included adjuvant chemotherapy and/or brachytherapy, early resumption of sexual activity, and low body mass index (mean, 23 ± 3.23 kg/m²). Dehiscences occurred regardless of suturing by staff or trainees. Review of operative videos did not reveal a detectable etiologic factor, such as excessive cautery damage to the vaginal cuff or shallow tissue sutured. All 7 colporrhexis repairs were performed through a vaginal approach without the need of laparoscopy or laparotomy.
  
  
  CONCLUSIONS
  Postoperative chemotherapy, brachytherapy, and early resumption of sexual activities are risk factors for vaginal vault dehiscence. Surgical technique, particularly the use of delayed absorbable sutures, deserves further evaluation.
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, Quebec, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Drudi
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Press
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.forename: Raphael
authors.initials: R
authors.lastname: Gotlieb
authors.forename: Jeffrey
authors.initials: J
authors.lastname: How
authors.forename: Ioana
authors.initials: I
authors.lastname: Eniu
authors.forename: Nancy
authors.initials: N
authors.lastname: Drummond
authors.forename: Sonya
authors.initials: S
authors.lastname: Brin
authors.forename: Claire
authors.initials: C
authors.lastname: Deland
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012196:Review Literature as Topic; D012307:Risk Factors; D012371:Robotics; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D014621:Vagina / Q000473:pathology* / Q000601:surgery