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

Authors

Amanda Marie Hill, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut. Electronic address: AmandaHillMD@gmail.com.
K Meryl Davis, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.
Lindsay Clark-Donat, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.
Lee Marvin Hammons, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.
Masoud Azodi, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.
Dan-Arin Silasi, Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.

Document Type

Article

Publication Title

Journal of minimally invasive gynecology

Abstract

UNLABELLED: 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.

First Page

108

Last Page

113

DOI

10.1016/j.jmig.2016.09.015

Publication Date

1-1-2017

Recommended Citation

Hill, Amanda Marie; Davis, K Meryl; Clark-Donat, Lindsay; Hammons, Lee Marvin; Azodi, Masoud; and Silasi, Dan-Arin, "The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy" (2017). Randomized Controlled Trial. 27.
https://scholar.bridgeporthospital.org/randomized_trial/27

Identifier

27702701 (pubmed); 10.1016/j.jmig.2016.09.015 (doi); S1553-4650(16)31105-0 (pii)