Comparative Study of Endosuturing Versus Transvaginal Suturing of Vault After Total Laproscopic Hysterectomy in aTertiary Care Hospital

Abstract

Introduction: Hysterectomy is the second most commonly performed gynecological procedure worldwide, with total laparoscopic hysterectomy (TLH) increasingly favored for its minimally invasive nature, faster recovery, and reduced morbidity. However, vaginal cuff dehiscence (VCD) remains a rare but serious complication, particularly following TLH. The optimal method for vaginal cuff closure (VCC) is still debated, with both endoscopic and transvaginal techniques in use. This study aimed to compare the safety and efficacy of endoscopic versus vaginal suturing for vault closure during TLH.

Materials and Methods: A prospective interventional single-blinded study was conducted at Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University from May 2023 to November 2024. Sixty women undergoing TLH for benign gynecological conditions were randomized into two groups: endoscopic closure (n=30) and vaginal closure (n=30). Demographic, clinical, intraoperative, and postoperative parameters were assessed. Primary outcomes included vault closure time, operative duration, and vault-related complications. Secondary outcomes included recovery time, ICU stay, and length of hospitalization. Data were analyzed using independent t-tests and Chi-square tests, with p<0.05 considered significant.

Results: Baseline characteristics were comparable between groups. Mean vault closure time was significantly longer in the endoscopic group (13.78 ± 4.06 min) than the vaginal group (4.41 ± 0.80 min, p<0.001). Total operative duration was higher in the endoscopic group, but the difference was not statistically significant (p=0.071). Postoperative recovery, hospital stay, and complication rates were similar across groups. Only one case of minor vaginal bleeding occurred in the vaginal closure group.

Conclusion: Both endoscopic and vaginal vault closure techniques following TLH are safe and effective. Although endoscopic suturing requires longer closure time initially. Once technical expertise and proficiency is attained, it offers a secure closure with comparable safety to vaginal suturing, supporting its use as a reliable option in minimally invasive hysterectomy.