Ikki Ai, Aoki Yoichi, Kanno Motoko, Tsumura Shiho, Fusegi Atushi, Abe Akiko, Netsu Sachiho, Omi Makiko, Tanigawa Terumi, Okamoto Sanshiro, Nomura Hidetaka, Kanao Hiroyuki
Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan.
Int J Gynaecol Obstet. 2025 Jul;170(1):222-232. doi: 10.1002/ijgo.16189. Epub 2025 Feb 1.
To analyze the rate of vaginal cuff dehiscence (VCD) by surgical approach and surgeons' experience.
In this observational, retrospective, cohort study, rates of VCD were calculated based on surgical approach, and VCD clinical characteristics were analyzed. Surgical routes of laparotomy, laparoscopy, and robotic surgery were compared. All minimally invasive surgeries were performed or supervised by a Japanese Society of Gynecology Obstetrics Endoscopy-certified laparoscopic surgeon.
There were 4864 hysterectomies in total: abdominal hysterectomies (n = 2578, 53.0%), laparoscopic hysterectomies (n = 1840, 37.8%), and robotic hysterectomies (n = 446, 9.2%). Among the 20 (0.411%) patients with VCD, the rate of VCD was highest for laparoscopic hysterectomy (0.706%), followed by robotic surgery (0.224%) and laparotomy (0.233%). Most causes of VCD were due to intercourse (50%), but 8 of 9 (88.8%) cases caused spontaneously or by defecation were laparoscopic cases. Defecation-related and spontaneous cases occurred significantly earlier after surgery than did intercourse-related cases (P = 0.008).
Our data showed a decrease in laparoscopic VCD compared with those of previous reports. VCD occurred more frequently with laparoscopy than with laparotomy, even when performed by experienced surgeons. Laparoscopic VCD often develops early with little external force applied. Problems with vaginal stump rigidity may be related to the surgical procedure.
按手术方式和术者经验分析阴道残端裂开（VCD）发生率。
在这项观察性、回顾性队列研究中，根据手术方式计算VCD发生率，并分析VCD临床特征。比较剖腹手术、腹腔镜手术和机器人手术的手术途径。所有微创手术均由日本妇产科内镜学会认证的腹腔镜外科医生实施或监督。
共进行了4864例子宫切除术：腹式子宫切除术（n = 2578，53.0%）、腹腔镜子宫切除术（n = 1840，37.8%）和机器人辅助子宫切除术（n = 446，9.2%）。在20例（0.411%）发生VCD的患者中，VCD发生率以腹腔镜子宫切除术最高（0.706%），其次是机器人手术（0.224%）和剖腹手术（0.233%）。VCD的大多数原因是性交（50%），但9例自发或因排便导致的病例中有8例（88.8%）为腹腔镜手术病例。与排便相关和自发的病例在术后发生的时间明显早于与性交相关的病例（P = 0.008）。
我们的数据显示，与既往报告相比，腹腔镜VCD发生率有所下降。即使由经验丰富的外科医生实施，腹腔镜VCD的发生率也高于剖腹手术。腹腔镜VCD常在外力作用较小的情况下早期发生。阴道残端硬度问题可能与手术操作有关。
