Vaginal Cuff Complications After Closure with an Endoscopic Device versus Conventional Suturing

Background: Proficiency with laparoscopic suturing is often the rate-limiting step in performing a total laparoscopic hysterectomy. Intracorporeal suturing is challenging due to difficulties with needle control and tissue handling. Endoscopic suturing devices may improve operator experience.

Objectives: To compare rates of vaginal cuff complications between cuff closures performed with an endoscopic device versus conventional laparoscopic instruments.

Methods: IRB-approved retrospective cohort study from 2018 to 2022. Data were stored in REDCap. Statistical analyses were performed with SAS 9.4.

Results: A total of 223 patients were included; 29 patients experienced a vaginal cuff complication (13%). There was a nonsignificant trend towards increased cuff complications in the Endo Stitch group (19.2% vs 11.4%, P = .16; OR = 1.8, 95% CI 0.78-4.38). Patients with an Endo Stitch closure had significantly more cases of cuff cellulitis (8.5% vs 0%, P = .002). There was no significant difference in pelvic fluid collections or abscess (2.1% vs 1.1%, P = .51). While all cases of cuff dehiscence occurred in the conventional closure group, the difference was not statistically significant (0% vs 2.8%, P = .59). There was no significant difference in vaginal bleeding (14.9% vs 9.1%, P = .24).

Conclusion: No significant difference was observed in composite vaginal cuff complications using barbed suture with the Endo Stitch device versus conventional laparoscopic instruments. However, the trend towards increased cuff complications and the significantly increased rates of cuff cellulitis observed with an Endo Stitch closure is concerning. As the current data is limited by a small sample size, both methods should be considered appropriate. However, more studies at higher power are needed.