Vaginal cuff closure at total laparoscopic hysterectomy (TLH): Laparoscopic suturing versus vaginal closure

Total laparoscopic hysterectomy (TLH), is fast replacing the conventional open procedure where and when feasible with greater public awareness and demand. Lesser disastrous major complications and affordability will help towards this trend in making it more popular. Any measures to improve and simplify and speed up this procedure demanding a higher level of skill, should be welcome. A total number of 62 TLH procedures, performed at the Teaching Hospital Peradeniya were followed up for a minimum of 4 months and analysed to see the speed and complications related to the method of vaginal cuff closure.Twenty six (42%) TLH procedures were done entirely trans abdominally with the laparoscope (A), and the rest 36 (58)% had the cuff closed manually, through vaginal approach (V). Complications directly attributable to surgery on the closure of the vaginal cuff itself were much higher with the abdominal technique-6 (23%) instances; but only 3 (8.3%) in the vaginal approach. The average vaginal closure time was over 3 times faster vaginally (19 vs 5.5min) with a lesser complication rate,making it the personal preference of the author as the research progressed explaining the higher proportion of vaginal closures.