Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial.

OBJECTIVES: To assess the effect of monopolar coagulation vs cut mode during colpotomy at total laparoscopic hysterectomy on vaginal cuff dehiscence.

STUDY DESIGN: We conducted this randomized controlled trial at a university hospital's department of obstetrics and gynecology from September 2016 through January 2018. Enrolled women were randomized 1:1 to monopolar coagulation or cut modes during colpotomy. We followed up 100 participants in the coagulation arm and 99 in the cut arm for ongoing data collection for 12 weeks after surgery. Exclusion criteria were suspicion of pregnancy, previous radiation therapy, uterine size exceeding 20 weeks' gestation, contraindication for high intraabdominal pressure, clinical advanced stage malignant disease, and conversion to laparotomy before completion of colpotomy. Differences between groups for categorical variables were analyzed by chi-square test and the comparisons of continuous variables between groups were analyzed by Student's t-test RESULTS: The study groups were comparable regarding demographics and perioperative parameters. The rate of vaginal cuff dehiscence in coagulation group (1%) was similar to that of cut group (0%) (p = 0.995). The other vaginal cuff related complication rates were also similar.

CONCLUSION: Monopolar coagulation and cut modes during colpotomy at total laparoscopic hysterectomy have similar vaginal cuff dehiscence rates and both energy modes seem acceptable for colpotomy.