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WJOLS

10.5005/jp-journals-10033-1187
REVIEW ARTICLE Vaginal Cuff Dehiscence after Minimal Invasive Hysterectomy: Laparoscopic Surgical Techniques
Vaginal Cuff Dehiscence after Minimal Invasive

Hysterectomy: Laparoscopic Surgical Techniques

Raquel Maciel, Tânia Freitas

ABSTRACT Despite the difficulty just described, it is reported that

Vaginal cuff dehiscence (VCD) after hysterectomy is an adverse the incidence of VCD after total laparoscopic hysterectomy
event with potential severe morbidity. Although the data are (TLH) varies between 0.3 and 3.1%. 3-10 This is higher
limited, minimally invasive approaches to hysterectomy, such compared with the abdominal (AH) and vaginal (VH)
as total laparoscopic hysterectomy (TLH), may be associated 1,3
with a higher risk of vaginal cuff dehiscence. The cause for these approach (0.1–0.3%). Currently, 50% of the cases of VCD
dehiscences is unknown, and multiple factors may be involved. that have been reported in the literature occurred after TLH
Internationally, the etiology of VCD is still a matter of concern. or robotic hysterectomy.
Either in its technique (TLH) as in the used technology After abdominal total hysterectomy, the vaginal cuff can
(electrosurgical colpotomy and/or suturing method), an
explanation could be found for the higher incidence of VCD. be sutured closed or left open. In the open technique, the
This study aims to review laparoscopic surgical techniques edges of the vaginal cuff seal gradually via granulation.
in the minimal invasive hysterectomy and its association It does not appear that either technique is superior for
with VCD.
preventing cuff dehiscence. 5,12
Keywords: Vaginal cuff dehiscence, Total laparoscopic In several studies, the vaginal route suturing of vault
hysterectomy, Vaginal cuff laparoscopic suture methods,
Electrosurgical colpotomy. approach, in the total laparoscopic hysterectomy, is described
10
to reduce the incidence of VCD (0.18%). However, other
How to cite this article: Maciel R, Freitas T. Vaginal Cuff
Dehiscence after Minimal Invasive Hysterectomy: Laparoscopic parameters must be considered are as follows:
Surgical Techniques. World J Laparosc Surg 2013;6(2):81-85. 1. In TLH, vaginal vault closure by laparoscopic route
requires statistically significant less time for completion
Source of support: Nil
as compared to vaginal route.
Conflict of interest: None declared
2. Postoperative complications, like vault infection and
INTRODUCTION pain, are suggested to be significantly lower in the
laparoscopic route as compared to vaginal route suturing
Vaginal cuff dehiscence (VCD) after hysterectomy is an for vault closure.
adverse event with potential severe morbidity. 3. The mean postoperative vaginal length was significantly
VCD had complicated gynecologic surgery long before more in the laparoscopic closure than in the vaginal route
the advent of laparoscopic approach to hysterectomy. In suturing of vault approach. Given the fact that
12
older reviews of vaginal evisceration, most cases that were transvaginal closure can not always be accomplished in
reported in the literature had occurred after vaginal all women, alternatives to this suturing method should
1
hysterectomy (63%). However, the distribution of reported be studied.
cases has changed significantly over the past 5 years. 2 Since, the continuous increment in the number of
The reported incidence of VCD following hysterectomy
3-5
is, nowadays, approximately 0.24%. In a large case series, hysterectomies performed laparoscopically, the etiology of
there were 28 cases of VCD among 11,606 patients VCD and explanations for its association with TLH have
5
(0.24%) who underwent total hysterectomy. The incidence been subjected to research. Patient characteristics, such as
of VCD after any type of pelvic surgery is 0.03% and varies smoking, diabetes, advanced age, radiation therapy and
by surgical approach. 6 chronic steroid administration, next to precipitating factors,
However, the true incidence of VCD after hysterectomy such as sexual intercourse, postoperative cuff infection and/
is unknown since: or hematoma and increased abdominal pressure (e.g.
1. The complication is likely under-reported. coughing, vomiting and straining at toilet) have been
2. Patients with cuff dehiscences may present to a different addressed with regard to their association with VCD. 4-6,13
physician or hospital than for the initial hysterectomy, Nevertheless, none of these factors are unique for TLH.
making data collection difficult and Because studies have pointed to the possibility of
3. Case reports of VCD generally do not include for increased risk of dehiscence with minimally invasive
comparison in the number of hysterectomies that were techniques, some potential differences in surgical technique
not associated with this complication. 7 that could contribute to this problem have been studied. 3,7
World Journal of Laparoscopic Surgery, May-August 2013;6(2):81-85 81