Unidirectional Barbed Suture for Vaginal-Cuff Closure in Laparoscopic and Robotic Hysterectomy

Abstract

Objective: The aim of this research was to estimate the incidence of vaginal-cuff dehiscence in patients undergoing total laparoscopic hysterectomy (TLH) or TLH with robotic assistance, using a unidirectional barbed suture compared to a vicryl suture. Materials and Methods: For this retrospective cohort study (Canadian Task Force Classification II-3), a total of 474 patient records were reviewed for women who underwent either TLH or TLH with robotic assistance. The procedures were performed by experienced minimally invasive gynecologic surgeons at a tertiary-care university-based teaching hospital and a community hospital from July 2010 to November 2012. Results: The overall incidence of vaginal-cuff dehiscence was 0.6%. There were 3 patients in the unidirectional barbed suture group diagnosed with vaginal cuff dehiscence, (0.8%, 95% CI: 0.2 to 2.4%), compared with no vaginal-cuff dehiscence in the delayed absorbable suture group (0.0%, 95% CI: 0.0% to 3.2%). One patient had recurrent dehiscence. There were no significant differences in postoperative bleeding, cellulitis, granulation tissue, or overall complications between the unidirectional and conventional suture groups (2.7% versus 1%; p = 0.47). Conclusions: Use of a unidirectional barbed suture for vaginal-cuff closure during TLH or TLH with robotic assistance does not increase the risk of vaginal-cuff dehiscence. (J GYNECOL SURG 32:167)