Introduction and objective
Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-Loc
TM
180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy.
Methods
A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia.
Results
Demographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups.
Conclusions
The unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.
Introduction: In India, cervical cancer stands as the 2nd most common female cancer and it is the 2nd most leading cause of deaths in women aged 15 to 44 years. The first visit to the gynecologist for most of the women in India is during pregnancy, thereby making it a fair opportunity for the screening of premalignant and malignant cervical disease. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India from January 2018 to January 2019. The Pap smear testing of 237 spontaneously conceived antenatal women, aging between 20 to 35 years was performed. The same women were followed up for postnatal testing after 6 weeks of delivery. Results: Out of 237, 8 women were reported positive for pre malignant lesions of cervix in the antenatal testing, 5 cases of ASCUS, 1 case of AGC, 1 case of ASC-H & 1 case of HSIL. In the postnatal Pap smear testing, 37 women were lost to follow-up including 1 case of ASCUS. Postnatal Pap smear testing of the remaining 200 women showed that 193 women who were reported NILM in the antenatal period remained unchanged in the postnatal screening too. Out of the 7 women who tested positive, 4 cases of ASCUS, 1 case of AGC and 1 case of ASC-H showed regression, giving result as NILM in the postnatal screening test. Out of the 7 positive antenatal tests, 1 case which was reported as HSIL in the antenatal screening, remained unchanged in the postnatal period.Conclusion: The study concluded that there is significant regression (p<0.01) of Positive Pap smear findings from antenatal to postnatal period. Hence, it is imperative to repeat Pap smear test in postnatal period.
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