Vaginal Cuff Dehiscence in Patients Undergoing Total Robotic and Laparoscopic Hysterectomy and the Use of Bidirectional Barbed Suture

Objective. The current literature suggests that robotic procedures appear to incur the greatest risk of vaginal cuff dehiscence. The purpose of this study is to compare the clinical outcomes in relation to vaginal cuff dehiscence in patients undergoing total robotic hysterectomy (TRH) compared to conventional total laparoscopic hysterectomy (TLH) and the use of bidirectional barbed suture. Methods. A retrospective cohort study was performed including women undergoing either conventional total robotic hysterectomy (TRH) or total laparoscopic hysterectomy (TLH) from January 1, 2004 to July 31, 2011 performed by a single surgeon. Age, weight, BMI, surgical procedure, EBL, vaginal cuff complication, dehiscence, DVT, and PE were evaluated. Chi square tests were used to determine associations in the contingency tables while for the continuous variables we used Student t test when appropriate or the Wilcoxon nonparametric test. All comparisons were two-sided where we used a Type I error of 0.05. Results. A total of 437 patient charts were evaluated, with TRH group n = 243 and TLH group n = 194. There was a lower estimated blood loss and slightly higher uterine weight (184.3 vs 183 g) in the TRH. Vaginal cuff dehiscence =1.3%, which was less among TRH (0.41%) vs TLH (2.58%), p = 0.053. Bidirectional barbed suture was used more often in the TRH group (46.5% in TRH vs 0.52% in TLH). 23 There was no significant decrease in the vaginal cuff dehiscence when a bidirectional barbed suture was used, (p = 0.92). Yet, among the TRH group the risk of vaginal cuff dehiscence was 2.5 times higher when conventional suture (2.1%, 1/47) was used vs quill suture (0.8%, 1/114). Conclusion. Although there is a reported increased risk of vaginal cuff dehiscence after robotic hysterectomy compared to laparoscopic hysterectomy, our study found that the incidence doubled among those undergoing a total laparoscopic hysterectomy. In our study, the use of bidirectional barbed suture seems to show a decreased trend in vaginal cuff complications among the robotic subgroup.