Impact of Barbed Suture Closure on Vaginal Cuff Dehiscence Following Robot-Assisted Total Hysterectomy: A Retrospective Cohort Study

Introduction Vaginal cuff dehiscence (VCD) is a rare but serious complication following hysterectomy, with a higher incidence in minimally invasive surgery (MIS). The choice of suture material and closure technique may influence the risk of VCD. Barbed sutures, such as STRATAFIX^™ Spiral PDS Plus, enhance tissue approximation and eliminate the need for knot tying, potentially improving wound healing. This study aimed to evaluate the incidence of VCD following robot-assisted total hysterectomy (RAH) with vaginal cuff closure using barbed sutures. Methods This retrospective cohort study included patients who underwent RAH at Kagoshima University Hospital between July 2017 and July 2024. Patients who had vaginal cuff closure with barbed sutures were analyzed, while those who underwent supracervical hysterectomy or had vaginal cuff closure with non-barbed sutures were excluded. VCD was assessed through pelvic examinations at one, three, and six months postoperatively, or earlier if clinically indicated. The presence or absence of VCD was determined based on findings within six months after surgery. All procedures were performed by certified gynecologic oncologists and laparoscopic surgeons using either the da Vinci^® Xi or hinotori^™ Surgical Robot System. Colpotomy was performed using monopolar coagulation (35 W), followed by vaginal cuff closure with interrupted 0-Polyglactin 910 sutures at the lateral ends and continuous barbed suture closure. Results A total of 313 patients were included, with a median age of 55 years and a median BMI of 28 kg/m². Of these, 270 (86%) had malignant conditions, while 43 (14%) had benign conditions. The median operative time was 201 minutes, and the median blood loss was 20 mL. Retroperitoneal suturing was performed in 224 patients (72%). No cases of VCD were observed. Conclusions This study demonstrates that vaginal cuff closure using barbed sutures during RAH is a feasible and safe technique, with no instances of VCD reported within the six-month postoperative period. The standardized surgical approach contributed to consistent outcomes across the cohort. These findings suggest that barbed suture closure may effectively reduce the risk of VCD, particularly in high-volume robotic surgery settings.