title: Dramatically reduced incidence of vaginal cuff dehiscence in gynecologic patients undergoing endoscopic closure with barbed sutures: A retrospective cohort study.
abstract: BACKGROUND
  This retrospective study documented the rate of vaginal cuff dehiscence (VCD) in a large series of gynecologic patients who were treated with an endoscopic (robotic-assisted or laparoscopic) hysterectomy that incorporated either delayed absorbable monofilament barbed or vicryl running sutures.
  
  
  METHODS
  We sought to discern any prognostic associations between operative variables (e.g., closure type (barbed or vicryl sutures), endoscopic approach (robotic-assisted or laparoscopic), and energy source (Harmonic Ace Shears or monopolar/bipolar electro-surgery)) and the risk for VCD via patient chart review. Statistical evaluation was comprised of univariate analyses and multiple regression.
  
  
  RESULTS
  We identified 1876 subjects; there were 14 cases (0% with barbed suture and 0.99% with vicryl suture) of VCD (an overall incidence of 0.75%), nearly all of which were associated with a robotic-assisted hysterectomy involving vicryl sutures (p = 0.034). However, the type of endoscopic surgery (P = 0.11) and energy source (P = 0.28) were not significant prognostic factors. The VCD patients' exhibited a median duration of 47 days (range, 14-116) until the development of their condition.
  
  
  CONCLUSIONS
  Vaginal cuff separation subsequent to laparoscopic closure is a rare occurrence. While our incidence of VCD was low and comparable to other reported rates in the literature, we did not observe any cases of VCD following laparoscopic hysterectomy performed with barbed suture closure.
authors.affiliation: Gynecologic Oncology Associates, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, United States.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rettenmaier
authors.affiliation: Gynecologic Oncology Associates, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, United States.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Abaid
authors.affiliation: Gynecologic Oncology Associates, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, United States.
authors.forename: John V
authors.initials: JV
authors.lastname: Brown
authors.affiliation: Gynecologic Oncology Associates, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, United States.
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Mendivil
authors.affiliation: Nancy Yeary Women's Cancer Research Foundation, Newport Beach, CA 92663, United States.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Lopez
authors.affiliation: Gynecologic Oncology Associates, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, United States. Electronic address: bram@gynoncology.com.
authors.forename: Bram H
authors.initials: BH
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011098:Polyglactin 910; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
chemical_list: D011098:Polyglactin 910
keywords: Barbed suture; Endoscopic surgery; Vaginal cuff dehiscence; Vicryl suture