Vaginal Cuff Closure after Total Laparoscopic Hysterectomy - Vaginal Vs Laparoscopic Approach?

Hysterectomy is the most frequent gynecologic surgical procedure. The benefits of laparoscopic hysterectomy are well known, and this technique is becoming more and more frequent. Vaginal cuff closure is an important and difficult step of the minimally invasive hysterectomy, requiring good laparoscopic surgical techniques. We carried out a review of the literature to determine if the laparoscopic closure of the vaginal cuff in total laparoscopic hysterectomy is superior to the vaginal approach in terms of vaginal cuff complications. The laparoscopic suture of the vaginal cuff during total laparoscopic hysterectomy was generally found to be inferior to the vaginal suture. The complex surgical skills required, too little tissue incorporated in the suture have been incriminated as possible causative factors. However, recent studies contradict these findings, and deem the laparoscopic closure of the vaginal cuff in total laparoscopic hysterectomy superior to the vaginal approach. The different results can be due to different surgical techniques, experience and materials, and should be subject to further research to clarify this matter.