Comparison of the incidence of vaginal cuff dehiscence by hysterectomy route and type based on experienced surgeons' outcome

Abstract

OBJECTIVE: To analyze the rate of vaginal cuff dehiscence (VCD) by surgical approach and surgeons' experience. METHOD: In this observational, retrospective, cohort study, rates of VCD were calculated based on surgical approach, and VCD clinical characteristics were analyzed. Surgical routes of laparotomy, laparoscopy, and robotic surgery were compared. All minimally invasive surgeries were performed or supervised by a Japanese Society of Gynecology Obstetrics Endoscopy-certified laparoscopic surgeon. RESULTS: There were 4864 hysterectomies in total: abdominal hysterectomies (n = 2578, 53.0%), laparoscopic hysterectomies (n = 1840, 37.8%), and robotic hysterectomies (n = 446, 9.2%). Among the 20 (0.411%) patients with VCD, the rate of VCD was highest for laparoscopic hysterectomy (0.706%), followed by robotic surgery (0.224%) and laparotomy (0.233%). Most causes of VCD were due to intercourse (50%), but 8 of 9 (88.8%) cases caused spontaneously or by defecation were laparoscopic cases. Defecation-related and spontaneous cases occurred significantly earlier after surgery than did intercourse-related cases (P = 0.008). CONCLUSION: Our data showed a decrease in laparoscopic VCD compared with those of previous reports. VCD occurred more frequently with laparoscopy than with laparotomy, even when performed by experienced surgeons. Laparoscopic VCD often develops early with little external force applied. Problems with vaginal stump rigidity may be related to the surgical procedure.