Page 25 - Peer Reviewed Laparoscopic Jornal

Raquel Maciel, Tânia Freitas

3. Why would be the preoperative morbility factors the 6. Croak AJ, Gebhart JB, Klingele CJ, Schroeder G, Lee RA,
cause for the superior incidence of VCD, in TLH? Are Podratz KC. Characteristics of patients with vaginal rupture and
evisceration. Obstet Gynecol 2004 Mar;103(3):572-576.
not the patients the same? 7. Hur HC. Vaginal cuff dehiscence after hysterectomy. UpToDate
4. What about postoperative conditions in TLH? Lower 2012 Oct. Available at: http://www.uptodate.com. Accessed
indices of pain, earlier work return, better predisposition November, 2012.
to restart sexual intercourse. Won’t be these advantages 8. Robinson BL, Liao JB, Adams SF, Randall TC. Vaginal cuff
of the laparoscopic procedures the mainly risk factors dehiscence after robotic total laparoscopic hysterectomy. Obstet
Gynecol 2009 Aug;114:369-371.
of VCD? 9. Agdi M, Al-Ghafri W, Antolin R, Arrington J, O’Kelley K,
Vaginal vault dehiscence is a rare complication Thomson AJ, Tulandi T. Vaginal vault dehiscence after
after hysterectomy, but more common after a hysterectomy. J Minim Invasive Gynecol 2009 May-June; 16(3):
313-317.
laparoscopic approach. The relationship between cuff 10. Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M,
dehiscence and mode of hysterectomy would be Bolis P. Vaginal cuff closure after minimally invasive
assessed best by a very large randomized controlled hysterectomy: our experience and systematic review of the
trial (RCT) study design. In fact, much of what is literature. Am J Obstet Gynecol 2011;205(2):119.e1-12.
known about VCD comes from case reports and case 11. Shen CC. Comparison of one- and two-layer vaginal cuff closure
series, which makes it difficult to truly assess possible and open vaginal cuff during laparoscopic-assisted vaginal
hysterectomy. J Am Assoc Gynecol Laparosc 2002 Nov;
risk factors and whether these risk factors differ by 9(4):474-480.
type of surgical procedure, mode of hysterectomy, etc. 12. Singh K, Shah B, Patel V, Goswami M, Shah MB. Vaginal vault
It is unknown whether variations in the surgical closure techniques in total laparoscopic hysterectomy: a
management of the vaginal cuff influence the risk of comparison between laparoscopic route vault suturing and
vaginal route suturing. Nati J Commun Med 2011;2(2):289-292.
dehiscence. 13. Blikkendaal MD, Twijnstra A, Pacquee S, Rhemrev JP, Smeets
Despite of this, techniques specific to TLH are MJ, De Kroor CD, Jansen FW. Vaginal cuff dehiscence in
pointed to be the main factor of the increased risk of laparoscopic hysterectomy: influence of various suturing methods
of the vaginal vault. Gynecol Surg 2012 Nov; 9(4):393-400.
vaginal vault dehiscence seen after laparoscopic 14. Jeung IC, Baek JM, Park EK, Lee HN, Kin CJ, Park TC, Lee
hysterectomy. YS. A prospective comparison of vaginal stump suturing
More research is necessary to identify modifiable techniques during total laparoscopic hysterectomy. Arch
risk factors for VCD and methods for its prevention. Gynecol Obstet 2010 Dec;282(6):631-638.
15. Lange S, Higgins R. Laparoscopic hysterectomy. Medscape
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ACKNOWLEDGMENT
com/article/1839957-overview. Accessed Novemer 2012.
I would like to thank Dr Rajneesh Mishra and all the 16. Einarsson J, Vellinga T, Twijnstra A, Chavan NR, Suzuki Y,
collaborators of the World Laparoscopy Hospital, New Greenberg JA. Bidirectional barbed suture: an evaluation of
safety and clinical outcomes. JSLS 2010 Jul-Sep;14(3):381-385.
Delhi, India for their valuable support. 17. Leung JC. Barbed suture technology: recent advances. Med
Textiles 2004 Oct;26-27:62-80.
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