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J Minim Invasive Gynecol. 2017 Jan 1;24(1):108-113. doi: 10.1016/j.jmig.2016.09.015. Epub 2016 Oct 1.

The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy.

Author information

1
Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut. Electronic address: AmandaHillMD@gmail.com.
2
Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.

Abstract

STUDY OBJECTIVE: To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse.

DESIGN:

A prospective randomized controlled trial. Subjects were randomly assigned to vertical or horizontal vaginal cuff closure at the time of total laparoscopic hysterectomy. Pelvic organ prolapse quantization (POP-Q) tests were performed before surgery, 2 to 4 weeks after surgery, and 3 to 4 months after surgery (Canadian Task Force classification I).

SETTING:

An academic university-affiliated community hospital.

PATIENTS:

Patients undergoing laparoscopic or robotic-assisted laparoscopic total hysterectomy for benign or malignant disease, excluding those undergoing radical hysterectomy or concomitant pelvic floor procedure.

INTERVENTIONS:

Subjects were randomized into the vertical or horizontal vaginal cuff closure group. Total hysterectomy was completed with traditional laparoscopic techniques or with robotic assistance. A colpotomy ring was used in each subject. Vaginal cuff closure was performed with barbed suture in a running fashion according to the group assignment.

MEASUREMENTS AND MAIN RESULTS:

A total of 43 subjects were enrolled and randomized. One patient was excluded because the vaginal cuff was closed vaginally, 1 cancelled surgery, and 1 was completed without a uterine manipulator. The mean change in vaginal length was -0.89 cm (standard deviation [SD] = 1.03) in the horizontal group and -0.86 cm (SD = 1.19) in the vertical group (p = .57). POP-Q evaluation revealed no differences between groups and an overall trend toward improved POP-Q measurements. The average duration of vaginal cuff closure did not differ (p = .45), and there were no intraoperative complications related to vaginal cuff closure.

CONCLUSION:

Horizontal and vertical laparoscopic closure of the vaginal cuff after laparoscopic hysterectomy results in similar changes in vaginal length and other POP-Q scores.

KEYWORDS:

Hysterectomy; Laparoscopy; Pelvic organ prolapse; Vaginal length

PMID:
27702701
DOI:
10.1016/j.jmig.2016.09.015
[Indexed for MEDLINE]

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