Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy

Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy

“…17 In the present study, VCD had no precipitating events in 27% of the women; in most cases VCD was associated with sexual intercourse, and in a few cases it was associated with physical activity, lifting, coughing, or straining. If VCD occurs during intercourse, it may later on increase sex-related stress and reduce sexual well-being.…”

“…In the first randomized study comparing laparoscopic and transvaginal cuff closure after TLH, avoiding vaginal intercourse for at least 2 months following surgery was recommended. 17 In the present study, VCD had no precipitating events in 27% of the women; in most cases VCD was associated with sexual intercourse, and in a few cases it was associated with physical activity, lifting, coughing, or straining. Previously, up to 70% of VCDs have been reported to occur spontaneously without predisposing activity.…”

“…5 However, no difference in major complications requiring reoperation was found between trainees and specialists in a later study 18. Nevertheless, a recent study reported that in centers with high laparoscopic expertise, the incidence of vaginal dehiscence is significantly lower when the entire procedure is completed laparoscopically compared with vaginal suturing of the cuff after TLH 17. However, the technique of vaginal opening and suturing in the study differs the one used in ours, and thus the results are not comparable.…”

Laparoscopic repair of the vaginal cuff dehiscence: Dehiscence occurring after the first sexual intercourse after the laparoscopic modified radical hysterectomy

“…This laparoscopic procedure is superior to abdominal approach because it is a minimally invasive surgery and is also superior to the vaginal approach in terms of vaginal length, which can influence the quality of sexual intercourse. Moreover, in the laparoscopic approach, surgeons can suture the peritoneum to prevent recurrence and to reduce the risk of hematoma and infection …”

“…Moreover, in the laparoscopic approach, surgeons can suture the peritoneum to prevent recurrence and to reduce the risk of hematoma and infection. 3,8 There are few reports on VCD repair by the total laparoscopic approach 4,5 describing its safety and efficacy. This is the first and second case in which total laparoscopic repair for VCD after TLmRH was performed.…”