Incidence and characteristics of vaginal cuff dehiscence in robotic-assisted and traditional total laparoscopic hysterectomy

This study compares the incidence of vaginal cuff dehiscence following robotic-assisted total laparoscopic hysterectomy (RALH) with total laparoscopic hysterectomy (TLH) and examines factors that may be related to risk. A retrospective chart review was performed for all patients undergoing RALH (n = 268), TLH (n = 463), and/or repair of vaginal cuff dehiscence at our clinic from July 2006 to January 2010. The cumulative incidence was calculated only for dehiscence that occurred after hysterectomies without evidence of malignancy. The incidence of cuff dehiscence in RALH (2.61%) versus TLH (1.94%) was not statistically significant (P = 0.60). However, among RALH patients, the overall incidence of cuff dehiscence after each surgeon’s first 25 cases was low at 0.85%. Mean time to presentation was similar in both groups, 8.2 weeks in RALH and 8.7 weeks in TLH, with sexual intercourse the most common inciting event. Where documented, records of dehisced patients showed that all colpotomy incisions were created using monopolar cautery and closed using 0 Vicryl sutures. In TLH, 87.5% of the colpotomy incisions were closed using the Endo Stitch device in a variety of fashions. While our findings show that the overall incidence of vaginal cuff dehiscence in RALH and TLH is comparable, the data also suggest that increased experience with robotic-assisted surgery may decrease dehiscence rates over time. Randomized controlled trials comparing different methods of colpotomy creation, particularly electrocautery, and cuff closure are needed to help guide us in the best surgical practices to reduce vaginal cuff dehiscence and related complications.