Hysterectomy how many stitches

Menopause , May Sources Incision Care After Surgery. Comprehensive Gynecology Center. March 29, Hot Flashes. February 10, Hysterectomy, Vaginal MedlinePlus.

August 14, Pain Control After Surgery. Cleveland Clinic. October 2, January 29, Postoperative Bleeding. January 30, Postoperative Fever. January 11, Precancerous Changes to the Cervix. Texas Oncology.

Journal of Mid-Life Health. April—June Health Topics. Health Tools. Reviewed: September 4, Medically Reviewed. Attached to the uterus on each side is a single fallopian tube and one ovary. Editorial Sources and Fact-Checking. Similarly, Tsafrir et al. Contrasting with these results, Landeen et al.

Their evaluation compared cuff closure with a single-layer continuous running suture and a single-layer continuous running suture with three reinforcing figure-of-eight sutures [ 43 ]. These findings suggest that reinforcing sutures reduce the rate of dehiscence. The benefit of these technical refinements can be better demonstrated in future clinical trials using sufficient sample size to detect differences in outcomes.

Overall, these limited studies provide insufficient data to demonstrate the superiority of a single cuff closure technique. Indeed, there are likely many acceptable techniques to close the vaginal cuff; an ideal technique may never be identified and likely varies based on the surgeon and the clinical situation. Regardless, the current paucity of the literature regarding the vaginal cuff closure technique in minimally invasive hysterectomy necessitates the development of large trials with adequate power.

Laparoendoscopic single-site surgery LESS is an advanced minimally invasive technique that has been recently introduced into clinical practice. This technique utilizes a single trocar for both optics and instrumentation, thus improving cosmetic outcomes and reducing complications related to the placement of ancillary trocars.

LESS is a surgically challenging platform because of poor ergonomics and restricted space for instruments, thus increasing instrument collision and making it more difficult to obtain adequate triangulation. These restrictions make closure of the vaginal cuff particularly challenging.

The ideal approach to vaginal cuff closure in robotic single-site hysterectomies is currently being refined, and few studies have evaluated the optimal approach for cuff closure.

Many studies of single-site hysterectomies use barbed sutures for vaginal cuff closure because these materials eliminate the need for intracorporeal knot-tying, which is particularly demanding in single-site surgery due to restricted movement and reduced space for instruments. Shin and colleagues describe an interesting technique using barbed sutures for vaginal cuff closure in single-site hysterectomy.

In a series of cases, they used a V-Loc unidirectional barbed suture with a straightened needle. They concluded that using a straightened needle for cuff closure results in shorter operative time and reduced technical difficulty [ 45 ]. Although barbed sutures may be easier to use in single-site surgery, surgeons should develop skills for intracorporeal knot-tying for this platform.

Akdemir et al. Using this technique, the surgeons found that the learning curve for intracorporeal suturing of the vaginal cuff in LESS reached a plateau at around 14 procedures, with a reduction of the average vaginal cuff closure time from Escobar et al. However, Paek et al. Regardless, these findings suggest that although the learning curve is steep for intracorporeal suturing of the vaginal cuff in LESS, it can be overcome with sufficient practice.

The utilization of LESS in gynecologic surgery is relatively new, with limited outcome data available. Yang et al. The procedure failure rate was mostly due to the requirement for extra ports, which would presumably be reduced with additional surgeon experience.

Similarly, increased operative time in single-site surgery could be related to surgeon experience and may be reduced after the surgeon is exposed to more single-site cases.

Notably, vaginal cuff closure is one of the most time-consuming steps in single-site hysterectomy. Postoperative outcomes were similar between single-site and multi-port hysterectomies, including postoperative pain and serious complications such as vaginal cuff dehiscence.

Although outcomes are similar between these techniques, single-port surgery has been associated with greater cosmetic satisfaction compared to two-port or four-port procedures [ 50 ]. Single-site surgery is still in its infancy in the field of gynecology.

The utilization of this technique for hysterectomy poses considerable technical challenges to the surgeon, especially during vaginal cuff closure. These challenges can result in increased operative duration, but the literature suggests that these hurdles can be overcome with sufficient experience. Similar postoperative outcomes between single-site and multi-port hysterectomy combined with improved cosmesis make LESS a viable alternative for traditional laparoscopic or robotic hysterectomy, especially for younger, non-obese patients in good physical condition.

There is a paucity of studies on optimal technique for vaginal cuff closure in single-site hysterectomy. Further trials are warranted to refine the approach to intracorporeal suturing of the vaginal cuff, one of the most challenging components of single-site hysterectomy. Vaginal cuff closure is a component of minimally invasive hysterectomy with significant variance in technique and suture choice between surgeons and institutions. Transvaginal suturing has been touted as a superior technique to laparoscopic sutures due to historically lower rates of vaginal cuff dehiscence.

However, new techniques and materials have been introduced that may improve the strength of laparoscopic and robotic closure. Since the introduction of barbed sutures, they have been shown to have utility in gynecologic surgery. Several studies suggest that a barbed suture may be superior to a conventional suture in postoperative outcomes and operative time, although the benefits are modest.

The increased cost of barbed sutures may be offset by reduced time in the operating room. Suture technique is a less-studied variable in vaginal cuff closure. The literature suggests that technical refinements, specifically the addition of reinforcing sutures, may provide benefit in postoperative outcomes. However, prospective trials with a large sample size are necessary to identify a superior technique.

The recent introduction of laparoendoscopic single-site surgery to the field of gynecology provides the possibility of further advancements in minimally invasive hysterectomy. The best technique for vaginal cuff closure in single-site surgery has not yet been established, as this is a cutting-edge field with few published trials. We believe that with new technologies and increased surgeon experience in minimally invasive techniques, intracorporeal vaginal cuff closure in minimally invasive hysterectomy will no longer be viewed as higher risk than transvaginal cuff closure.

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The authors have declared that no competing interests exist. National Center for Biotechnology Information , U. Journal List Cureus v. Published online Oct Katherine Smith 1 and Aileen Caceres 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Katherine Smith ude. Received Aug 2; Accepted Oct This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This article has been cited by other articles in PMC. Abstract Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions.

Keywords: minimally invasive surgery, laparoscopy, laparoscopic hysterectomy, vaginal cuff, hysterectomy, robotic surgery, barbed suture, knotless suture, vaginal cuff dehiscence, single site surgery. Introduction and background Hysterectomy is one of the most common surgeries performed on women in the United States, with approximately , performed each year [ 1 - 2 ].

Review Laparoscopic suturing techniques Intracorporeal suturing with laparoscopy is an essential skill for minimally invasive gynecologic surgery. Open in a separate window. Figure 1. Looped technique of intracorporeal suturing The suture is grasped by the right needle driver. Figure 2. Coiled technique for intracorporeal suturing The left needle driver grasps the suture distal to the needle Panel A.

Figure 3. Table 1 Training models constructed for laparoscopic and robotic vaginal cuff closure skill development. Vaginal cuff closure King et al. Vaginal cuff closure Tunitsky-Bitton et al. Vaginal cuff closure Finan et al. Vaginal cuff closure. Table 3 Postoperative outcomes evaluated by studies comparing barbed sutures and conventional sutures for vaginal cuff closure Effects are reported as the barbed suture group relative to the control group of conventional suture materials unless otherwise specified i.

No significant difference for other outcomes. Tsafrir et al. Conclusions Vaginal cuff closure is a component of minimally invasive hysterectomy with significant variance in technique and suture choice between surgeons and institutions. Acknowledgments The authors would like to thank Mr. Footnotes The authors have declared that no competing interests exist. References 1. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol.

Hysterectomy rates in the United States, Extirpation of the uterus and ovaries for sarcomatous disease. Burnham W. Nelson's Am Lancet. Laparoscopic hysterectomy. J Gynecol Surg. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. Inpatient laparoscopic hysterectomy in the United States: trends and factors associated with approach selection.

J Minim Invasive Gynecol. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study. Effects of electrosurgery and vaginal closure technique on postoperative vaginal cuff dehiscence. Comparison of 2 methods of vaginal cuff closure at laparoscopic hysterectomy and their effect on female sexual function and vaginal length: a randomized clinical study.

Intracorporeal knot-tying and suturing techniques in laparoscopic surgery: technical details. Croce E, Olmi S. A comparative study in learning curves of two different intracorporeal knot tying techniques. Thiyagarajan M, Ravindrakumar C. Minim Invasive Surg. Lapra-Ty holding strength and slippage with various suture types and sizes. If a womn follows the recommendations below, her body will heal quickly and successfully after a vaginal hysterectomy:. The ACOG reports that a hysterectomy is safe and has a low risk of complications when performed by a qualified surgeon.

Though uncommon, complications include:. An individual can expect certain long-term effects after her uterus has been removed. These include:. Depending on the route of a hysterectomy, a woman will still need regular Pap tests if the cervix was not removed. Other screenings also may be needed if cancer or precancerous cells are found. Some women experience depression , emotional changes, or a sense of loss after a hysterectomy. They may also find that their interest in sex changes, especially if the ovaries were removed.

If a woman Is struggling with any of these issues, they can talk with a doctor who can offer advise on support, therapy, or medications that may be helpful.

It is less invasive than other types of hysterectomy, recovery is usually faster and easier, and there is no visible scar. In some cases, a vaginal hysterectomy is not appropriate, and other kinds of hysterectomy are recommended instead. This is a decision that should be made jointly with a woman and her gynecologist.

A hysterectomy may involve more than the removal of just the uterus. The variations in this surgery include:. When the fallopian tubes are removed it is called a salpingectomy, and when the ovaries are removed it is called oophorectomy. When talking with a doctor about surgery, a person should make sure they ask if these procedures are planned in addition to the hysterectomy.

Most women recover quickly from a vaginal hysterectomy and can get back to healthy, active lives. Making an informed decision about a vaginal hysterectomy will require a conversation with a gynecologist and surgeon to determine whether this surgery is the best option. Learn more about what to expect during the procedure and recovery. Adenomyosis is a condition where cells from the uterus lining grow into the uterus muscle. It is related to endometriosis and has similar symptoms….