LAUSR

STUDY OBJECTIVE Primary: Assess effect of route of vaginal cuff closure on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy. Secondary: Assess patient and surgical risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications. DESIGN Retrospective chart review with case-control component SETTING: : Tertiary care center (main hospital and regional hospitals) PATIENTS: : 1278 women underwent laparoscopic (LH) or robotic-assisted (RAH) hysterectomy in 2016 and met inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016. INTERVENTIONS A retrospective comparison of patients with vaginal (VCC) and laparoscopic (LCC) cuff closure undergoing LH and RAH in 2016. Patients with VCD from 2009 to 2016 (n=26) were matched by route of cuff closure to the next 7 hysterectomies (n=182) which became controls. MEASUREMENTS AND MAIN RESULTS In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC=8/989 (0.81%) and VCC 1/289 (0.35%, p= .41). 7 VCD cases were performed by high volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in rates of perioperative complications or surgeon volume between routes of cuff closure. Case control patients differed in smoking status (p= .010) and history of prior laparotomy (p= .017). Logistic regression showed increasing age (OR 0.95, CI 0.91-0.99) and increasing BMI (OR 0.98, CI 0.83-0.97) were protective for VCD. CONCLUSIONS VCD is a rare but serious complication of laparoscopic hysterectomy. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend surgeons employ the closure technique they are best accustomed with to optimize patient outcomes.