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Vaginal Vault Dehiscence After Robotic Hysterectomy for Gynecologic Cancers: Search for Risk Factors and Literature Review
  1. Laura Drudi, MS*,,,
  2. Joshua Z. Press, MD*,,
  3. Susie Lau, MD*,
  4. Raphael Gotlieb, BS*,
  5. Jeffrey How, MS*,,
  6. Ioana Eniu, Ing*,
  7. Nancy Drummond, BN*,
  8. Sonya Brin, BN*,
  9. Claire Deland, BN* and
  10. Walter H. Gotlieb, MD, PhD*,
  1. *Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital,
  2. Lady Davis Institute of Medical Research, and
  3. Department of Undergraduate Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
  1. Address correspondence and reprint requests to Walter H. Gotlieb, MD, PhD, McGill University 3755 Cote Ste, Catherine Rd, Montreal, Quebec, Canada H3T 1E2. E-mail: walter.gotlieb@mcgill.ca.

Abstract

Introduction Vaginal vault dehiscence following robotic-assisted hysterectomy for gynecologic cancer may be attributed to surgical techniques and postoperative therapeutic interventions. We searched for risk factors in patients with gynecologic cancers and complemented this with a literature review.

Methods Evaluation of prospectively gathered information on all consecutive robotic surgeries for gynecologic cancers was performed in a tertiary academic cancer center between December 2007 and March 2012. The literature was reviewed for articles relevant to “gynecologic oncology” and “robotics” with “vaginal cuff dehiscence” in the English and French languages. Respective authors were contacted to complete relevant information.

Results Seven dehiscences were identified of 441 cases with established gynecologic cancers. The closures in these 7 were performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%), combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156, 1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk factors included adjuvant chemotherapy and/or brachytherapy, early resumption of sexual activity, and low body mass index (mean, 23 ± 3.23 kg/m2). Dehiscences occurred regardless of suturing by staff or trainees. Review of operative videos did not reveal a detectable etiologic factor, such as excessive cautery damage to the vaginal cuff or shallow tissue sutured. All 7 colporrhexis repairs were performed through a vaginal approach without the need of laparoscopy or laparotomy.

Conclusions Postoperative chemotherapy, brachytherapy, and early resumption of sexual activities are risk factors for vaginal vault dehiscence. Surgical technique, particularly the use of delayed absorbable sutures, deserves further evaluation

  • Robotic-assisted hysterectomy
  • Vaginal cuff dehiscence

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Footnotes

  • The Israel Cancer Research Foundation, The Week-End to End Women Cancers, and Gloria’s Girls supported this work.

  • The authors declare no conflicts of interest.

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