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Chapter-09 Vaginal Cuff Closure Following Total Laparoscopic Hysterectomy

BOOK TITLE: ISARCON 2017 Manual of Laparoscopic Endosuturing

Author
1. Jain Nutan
2. Hakim Mohsina
ISBN
9789352700745
DOI
10.5005/jp/books/14174_10
Edition
1/e
Publishing Year
2018
Pages
3
Author Affiliations
1. Vardhman Infertility and Endoscopy Centre, Muzaffarnagar (UP), India, Vardhman Trauma & Laparoscopy Centre Pvt Ltd, Muzaffarnagar, UP, India, Vardhman Super Specialty Hospital, Muzaffarnagar, Uttar Pradesh, India, Vardhman Trauma and Laparoscopy, Centre Pvt Ltd, Muzaffarnagar, Uttar Pradesh, India, Vardhman Trauma and Laparoscopy, Center Pvt Ltd, Muzaffarnagar, Uttar Pradesh, India, Muzaffarnagar (UP), Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India, Muzaffarnagar, Vardhman Trauma and Laparoscopy Center, Muzaffarnagar, Uttar Pradesh, India, Vardhman Trauma and Laparoscopy Centre Pvt Ltd, Muzaffarnagar, Uttar Pradesh, India, Vardhman Hospital Muzzafarnagar, UP, India, Vardhman Trauma & Laparoscopy Centre Pvt. Ltd, A-36, South Civil Lines, Mahavir Chowk, Muzaffarnagar 251 001, UP, India, Vardhman Trauma and Laparoscopy Center (P) Ltd, Uttar Pradesh, India, Vardhman Trauma and Laparoscopy Center (P) Ltd, Muzaffarnagar, Uttar Pradesh, India, Vardhman Infertility and Endoscopy Centre
Chapter keywords
Total laparoscopic hysterectomy, vaginal cuff closure, vaginal cuff dehiscence, vaginal vault suturing, curved needle suturing, interrupted suture, continuous suture, half moon effect, ipsilateral port

Abstract

The chapter lays down techniques of vaginal cuff closure following total laparoscopic hysterectomy, avoiding the complication of vaginal cuff dehiscence. One should select an ideal suture material for closure of the vaginal cuff that inhibits bacterial growth, provokes minimal tissue reactivity, and is flexible, malleable, and absorbable, but maintains reasonable tensile strength for at least 2 to 4 weeks. Chromic catgut is avoided as it causes increased postoperative formation of granulation. Next, the chapter lists down the closure techniques as continuous and interrupted. The vaginal cuff can be sutured in one layer or in two layers. Suturing of the vaginal vault is the easiest and, in fact, the best surgical area to practice continuous curved needle suturing.

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