title: Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: A randomized controlled trial.
abstract: OBJECTIVE
  This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy.
  
  
  METHODS
  Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty®(Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding.
  
  
  RESULTS
  The study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed.
  
  
  CONCLUSIONS
  The type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons' preference and cost effectiveness.
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA; The Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel- Aviv, Israel. Electronic address: zivtsafrir@gmail.com.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Tsafrir
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Palmer
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Dahlman
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: A Karim
authors.initials: AK
authors.lastname: Nawfal
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Aoun
authors.affiliation: Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Theoharis
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
authors.forename: David
authors.initials: D
authors.lastname: Eisenstein
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D065287:Robotic Surgical Procedures / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects / Q000706:statistics & numerical data*
keywords: Barbed suture; Braided suture; Robotic hysterectomy; Vaginal closure techniques; Vaginal cuff dehiscence