Togami Shinichi, Nozomi Furuzono, Kobayashi Yusuke, Fukuda Mika, Mizuno Mika, Yanazume Shintaro, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, JPN.
Cureus. 2025 Apr 3;17(4):e81672. doi: 10.7759/cureus.81672. eCollection 2025 Apr.
Introduction Vaginal cuff dehiscence (VCD) is a rare but serious complication following hysterectomy, with a higher incidence in minimally invasive surgery (MIS). The choice of suture material and closure technique may influence the risk of VCD. Barbed sutures, such as STRATAFIX Spiral PDS Plus, enhance tissue approximation and eliminate the need for knot tying, potentially improving wound healing. This study aimed to evaluate the incidence of VCD following robot-assisted total hysterectomy (RAH) with vaginal cuff closure using barbed sutures. Methods This retrospective cohort study included patients who underwent RAH at Kagoshima University Hospital between July 2017 and July 2024. Patients who had vaginal cuff closure with barbed sutures were analyzed, while those who underwent supracervical hysterectomy or had vaginal cuff closure with non-barbed sutures were excluded. VCD was assessed through pelvic examinations at one, three, and six months postoperatively, or earlier if clinically indicated. The presence or absence of VCD was determined based on findings within six months after surgery. All procedures were performed by certified gynecologic oncologists and laparoscopic surgeons using either the da Vinci Xi or hinotori Surgical Robot System. Colpotomy was performed using monopolar coagulation (35 W), followed by vaginal cuff closure with interrupted 0-Polyglactin 910 sutures at the lateral ends and continuous barbed suture closure. Results A total of 313 patients were included, with a median age of 55 years and a median BMI of 28 kg/m². Of these, 270 (86%) had malignant conditions, while 43 (14%) had benign conditions. The median operative time was 201 minutes, and the median blood loss was 20 mL. Retroperitoneal suturing was performed in 224 patients (72%). No cases of VCD were observed. Conclusions This study demonstrates that vaginal cuff closure using barbed sutures during RAH is a feasible and safe technique, with no instances of VCD reported within the six-month postoperative period. The standardized surgical approach contributed to consistent outcomes across the cohort. These findings suggest that barbed suture closure may effectively reduce the risk of VCD, particularly in high-volume robotic surgery settings.
引言 阴道残端裂开（VCD）是子宫切除术后一种罕见但严重的并发症，在微创手术（MIS）中的发生率较高。缝合材料和闭合技术的选择可能会影响VCD的风险。倒刺缝线，如STRATAFIX Spiral PDS Plus，可增强组织对合，无需打结，可能改善伤口愈合。本研究旨在评估使用倒刺缝线进行阴道残端闭合的机器人辅助全子宫切除术（RAH）后VCD的发生率。
方法 这项回顾性队列研究纳入了2017年7月至2024年7月在鹿儿岛大学医院接受RAH的患者。分析使用倒刺缝线进行阴道残端闭合的患者，排除接受次全子宫切除术或使用非倒刺缝线进行阴道残端闭合的患者。术后1个月、3个月和6个月通过盆腔检查评估VCD，如有临床指征则提前评估。根据术后6个月内的检查结果确定是否存在VCD。所有手术均由认证的妇科肿瘤学家和腹腔镜外科医生使用da Vinci Xi或hinotori手术机器人系统进行。采用单极电凝（35W）进行阴道切开术，然后在两端用间断0号聚乙醇酸910缝线进行阴道残端闭合，并使用连续倒刺缝线进行闭合。
结果 共纳入313例患者，中位年龄55岁，中位BMI为28kg/m²。其中，270例（86%）患有恶性疾病，43例（14%）患有良性疾病。中位手术时间为201分钟，中位失血量为20mL。224例（72%）患者进行了腹膜后缝合。未观察到VCD病例。
结论 本研究表明，RAH期间使用倒刺缝线进行阴道残端闭合是一种可行且安全的技术，术后6个月内未报告VCD病例。标准化的手术方法有助于整个队列获得一致的结果。这些发现表明，倒刺缝线闭合可能有效降低VCD风险，尤其是在高容量机器人手术环境中。
