Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, Quebec, Canada.
Int J Gynecol Cancer. 2013 Jun;23(5):943-50. doi: 10.1097/IGC.0b013e31828f38e1.
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.
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.
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.
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.
妇科癌症患者行机器人辅助子宫切除术（robotic-assisted hysterectomy）后发生阴道穹窿裂开，可能与手术技术和术后治疗干预有关。我们在一家三级学术癌症中心对所有连续的妇科癌症机器人手术进行了前瞻性评估，并结合文献复习寻找风险因素。
评估 2007 年 12 月至 2012 年 3 月期间在一家三级学术癌症中心进行的所有妇科癌症机器人手术的前瞻性信息。检索了英文和法文文献中关于“妇科肿瘤学”和“机器人技术”以及“阴道残端裂开”的文章。联系了各自的作者以获取相关信息。
在 441 例确诊妇科癌症患者中，发现了 7 例阴道穹窿裂开。这 7 例的缝合方法分别为间断 1-薇乔缝线（Ethicon Inc）（3/167；1.8%）、间断 1-薇乔缝线和 1-贝森缝线（Covidien Inc）（3/156，1.9%）和 V-Loc 缝线（Covidien Inc）（1/118，0.8%）。相关危险因素包括辅助化疗和/或近距离放射治疗、早期恢复性生活和低体重指数（平均 23 ± 3.23 kg/m²）。无论缝合由工作人员还是实习生完成，均发生了裂开。对手术录像的审查并未发现可察觉的病因，如阴道残端过度电灼损伤或浅层组织缝合。所有 7 例阴道残端修复均通过阴道途径进行，无需腹腔镜或剖腹术。
术后化疗、近距离放射治疗和早期恢复性生活是阴道穹窿裂开的危险因素。手术技术，特别是延迟可吸收缝线的使用，值得进一步评估。
