title: Histologic characteristics of vaginal cuff tissue from patients with vaginal cuff dehiscence.
abstract: OBJECTIVE
  To describe the histologic characteristics of vaginal tissue in patients with vaginal cuff dehiscence (VCD) after robotic hysterectomy and to compare this group with patients without dehiscence.
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-3).
  
  
  METHODS
  Academic center.
  
  
  METHODS
  Seven patients with VCD and 6 patients without VCD.
  
  
  METHODS
  Vaginal cuff tissue was obtained from all patients and was stained using hematoxylin-eosin and evaluated for acute and chronic inflammation markers including neutrophils, lymphocytes, and plasma cells. Immunohistochemical staining was performed and evaluated using the semiquantitative method for collagen types I and III, smooth muscle actin, and SM22α (myofibroblast) content. Grading was performed by 4 blinded investigators. The Mann-Whitney test was used to evaluate the 2 groups, and correlation coefficients for interobserver variability.
  
  
  RESULTS
  The VCD group, compared with the non-VCD group, demonstrated significantly greater numbers of neutrophils (1.71 vs 1.0; p = .04), lymphocytes (2.85 vs 1.33; p = .002), and plasma cells (2.2 vs 1.0; p = .001). There was no statistical difference between the groups in amounts of collagen I (1.71 vs 1.27; p = .09) and collagen III (1.66 vs 1.38; p = .37), smooth muscle actin (1.23 vs 1.33; p = .65), and SM22α (1.85 vs 1.27; p = .09). Interobserver variability was low (κ = 0.86; p = .76).
  
  
  CONCLUSIONS
  Compared with the control group, patients with VCD demonstrated significantly higher levels of acute and chronic inflammatory cells. This finding suggests that a prolonged inflammatory phase may be delaying normal progression to reparation in patients with dehiscence.
authors: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix. Electronic address: Jennifer@academic-urology.com.
authors: Jennifer
authors: J
authors: Klauschie
authors: Department of Obstetrics and Gynecology, Stanford Medical Center, Stanford, California.
authors: Yan
authors: Y
authors: Wen
authors: Department of Obstetrics and Gynecology, Stanford Medical Center, Stanford, California.
authors: Bertha
authors: B
authors: Chen
authors: Department of Obstetrics and Gynecology, Stanford Medical Center, Stanford, California.
authors: Lu
authors: L
authors: Zhou
authors: Department of Urology, Mayo Clinic Arizona, Phoenix.
authors: Raphael
authors: R
authors: Nunez-Nateras
authors: Department of Pathology, Mayo Clinic Arizona, Phoenix.
authors: Idris T
authors: IT
authors: Ocal
authors: Department of Pathology, Mayo Clinic Arizona, Phoenix.
authors: Dora
authors: D
authors: Lam-Himlin
authors: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix.
authors: Rosanne
authors: R
authors: Kho
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D013529:Surgical Wound Dehiscence / Q000473:pathology*; D014621:Vagina / Q000473:pathology*
keywords: Histologic characteristics; Robotics; Vaginal cuff dehiscence