Barbed Suture in Total Laparoscopic Hysterectomy: A Comparative Study of the Safety in Vaginal Cuff Closure with that of Polyglactin 910 Suture

The vaginal route for minimally invasive surgery: a practical guide for general surgeons

INTRODUCTION

Vaginal approaches have become routine in the field of gynecologic surgery, whereas in general surgery vaginal wall transection is an infrequent practice typically reserved for extensive tumor resections. Approximately two decades ago, natural orifice transluminal endoscopic surgery (NOTES) revolutionized conventional boundaries by accessing the peritoneal cavity transorally, transrectally, or transvaginally, enabling general surgery without visible scars. Although transvaginal approaches have been successfully used for various abdominal procedures by general surgeons, a gap remains in comprehensive training to fully exploit the potential of this route.

MATERIAL AND METHODS

PubMed, Google Scholar, and Scopus databases were searched to retrieve relevant articles illustrating how general surgeons can adeptly manage vaginal approaches.

RESULTS

The article presents a practical framework for general surgeons to execute a complete vaginal approach, addressing the management of vaginal specimen extraction and vaginal cuff closure, even in the absence of an experienced gynecologist.

CONCLUSION

The evolution of abdominal surgery is moving towards less invasive techniques, emphasizing the importance of understanding the nuances and challenges associated with the vaginal route. This approach is linked to minimal oncological, sexual, and infective complications, and to the absence of pregnancy-related complications. Such knowledge becomes increasingly crucial, particularly with the renewed demand for transvaginal access in robot-assisted NOTES procedures.

Vaginal Vault Closure Following Total Laparoscopic Hysterectomy: Laparoscopic versus Conventional Technique - A Comparative Study

Objectives

Vault closure is the final step to hysterectomy, protecting the abdominal cavity from the exterior environment. Thus, closure becomes crucial in preventing ascend of infection to the peritoneal cavity. Our study aims to compare vault closure between laparoscopic and vaginal routes, their operating time, and postoperative complications.

Materials and Methods

The ambispective comparative study was done in a tertiary care teaching center from June 2016 to December 2022. Three hundred and forty-four patients were included in the study that underwent a total laparoscopic hysterectomy. Interventions - Patients who had laparoscopic vault closure were in Group 1 (N = 198) and those who had vaginal closure were in Group 2 (N = 146). The results were compared. It included age, body mass index of the patient, the indication of surgery, intraoperative blood loss, size of the uterus, time taken during vault closure, and postoperative complications.

Results

The time taken by laparoscopic vault repair was significantly less than vaginal repair (19.7 ± 13.3 min vs. 30.1 ± 6.6 min, P < 0.001). There was postoperative vault infection (2.7%), vault hematoma (1.3%), and no vault prolapse seen in vaginal repair. The organisms isolated were mainly Pseudomonas aeruginosa, Escherichia coli, and Klebsiella.

Conclusion

Laparoscopic vault closure has shown significantly improved results compared to vaginal route repair.

Postoperative small intestinal obstruction caused by barbed suture after robot-assisted laparoscopic sacrocolpopexy

Introduction

We present a case of small intestinal obstruction due to a barbed suture used for peritoneal closure during robot-assisted laparoscopic sacrocolpopexy.

Case presentation

A female patient with pelvic organ prolapse underwent robot-assisted laparoscopic sacrocolpopexy uneventfully. Intestinal obstruction developed on postoperative Day 4. Conservative treatment with the ileus tube failed to improve abdominal symptoms. The laparoscopic examination on postoperative Day 14 revealed the barbed suture entangled with the small intestinal mesentery. The tail of the barbed suture was laparoscopically detached from the mesentery without damaging the small intestine. The tail of the barbed suture was trimmed; an antiadhesive material was applied to the peritoneal closure line and the trimmed tail of the barbed suture.

Conclusion

We recommend the use of conventional absorbable sutures in the peritoneal cavity because of the potential risk of intestinal obstruction caused by the barbed suture.

Surgical Morbidity of Laparoscopic Hysterectomy versus Abdominal Hysterectomy: A Retrospective Overview

Objectives

Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. The need for reliable training and its assessment is becoming increasingly important with the course of time.

Materials and Methods

A retrospective comparative study was done in a tertiary care center where all patients undergoing hysterectomy by laparoscopic and abdominal route were included in the study.

Objectives

Our study aims to compare the operative and postoperative complications of laparoscopic hysterectomy with abdominal hysterectomy. The study was conducted from June 2016 to October 2022.

Results

The mean operative time for uteri size lesser than 12 weeks was found significant in the total laparoscopic hysterectomy (TLH) group (75 ± 25 min) to total abdominal hysterectomy (TAH) (117 ± 28 min, P < 0.001). The mean blood loss in the TLH group was significant (110 ± 30 ml vs. 160 ± 116 ml, P < 0.002). The mean hospital stay was significantly shorter in TLH (4 ± 2.4 days vs. 7 ± 2.41 days, P < 0.002). The operative and postoperative complications observed were 3.1% in the TLH group and 11.7% in the TAH group.

Conclusion

TLH when performed efficiently has proved to be a preferable route over other conventional hysterectomies.

Prevention and management of vaginal cuff dehiscence: an updated review

PURPOSE OF REVIEW

Minimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy.

RECENT FINDINGS

Recent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence.

SUMMARY

The focus of this review is to help surgeons identify patient risk factors and address them preoperatively and to review surgical techniques that can minimize the risk of vaginal cuff dehiscence.