title: Analysis of a Standardized Technique for Laparoscopic Cuff Closure following 1924 Total Laparoscopic Hysterectomies.
abstract: Objective. To review the vaginal cuff complications from a large series of total laparoscopic hysterectomies in which the laparoscopic culdotomy closure was highly standardized. Methods. Retrospective cohort study (Canadian Task Force Classification II-3) of consecutive total and radical laparoscopic hysterectomy patients with all culdotomy closures performed laparoscopically was conducted using three guidelines: placement of all sutures 5 mm deep from the vaginal edge with a 5 mm interval, incorporation of the uterosacral ligaments with the pubocervical fascia at each angle, and, whenever possible, suturing the bladder peritoneum over the vaginal cuff edge utilizing two suture types of comparable tensile strength. Four outcomes are reviewed: dehiscence, bleeding, infection, and adhesions. Results. Of 1924 patients undergoing total laparoscopic hysterectomy, 44 patients (2.29%) experienced a vaginal cuff complication, with 19 (0.99%) requiring reoperation. Five patients (0.26%) had dehiscence after sexual penetration on days 30-83, with 3 requiring reoperation. Thirteen patients (0.68%) developed bleeding, with 9 (0.47%) requiring reoperation. Twenty-three (1.20%) patients developed infections, with 4 (0.21%) requiring reoperation. Three patients (0.16%) developed obstructive small bowel adhesions to the cuff requiring laparoscopic lysis. Conclusion. A running 5 mm deep × 5 mm apart culdotomy closure that incorporates the uterosacral ligaments with the pubocervical fascia, with reperitonealization when possible, appears to be associated with few postoperative vaginal cuff complications.
authors: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Road, Portola Valley, CA 94028, USA.
authors: Katherine A
authors: 0000-0002-7577-4188
authors: KA
authors: O'Hanlan
authors: University of California at San Francisco-Fresno, 155 North Fresno Street, Fresno, CA 93701, USA.
authors: Pamela L
authors: 0000-0001-8243-4387
authors: PL
authors: Emeney
authors: University of California at San Francisco-Fresno, 155 North Fresno Street, Fresno, CA 93701, USA.
authors: Alfred
authors: A
authors: Peters
authors: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Road, Portola Valley, CA 94028, USA.
authors: Margaret S
authors: MS
authors: Sten
authors: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Road, Portola Valley, CA 94028, USA.
authors: Stacey P
authors: 0000-0001-8618-1604
authors: SP
authors: McCutcheon
authors: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Road, Portola Valley, CA 94028, USA.
authors: Danielle M
authors: 0000-0001-9521-3671
authors: DM
authors: Struck
authors: Laparoscopic Institute for Gynecology and Oncology, 4370 Alpine Road, Portola Valley, CA 94028, USA.
authors: Joseph K
authors: 0000-0001-6885-7682
authors: JK
authors: Hoang