Efficacy of suturing the cardinal and uterosacral ligaments to the vaginal cuff as primary preventive measure during laparoscopic / robotic hysterectomy in preventing vault prolapse: A retrospective prospective study

The long term effect of laparoscopic hysterectomy on the pelvic floor is not well studied.Objective: Is to compare incidence of POP post TLH with endosuturing or vaginal closure of vault in women undergoing hysterectomy for benign conditions other than prolapse.Methodology: This is a retrospective, prospective study analyzing 140 women who underwent lap or robotic hysterectomy under a single, senior MIS Surgeon at a tertiary care hospital between 2017 to 2022 and were followed up till 2024. The patients were divided into 2 groups basing on mode of suturing of vault.Group 1: Endo suturing with 1-0 v-loc (USLcomplex was included under vision)Group 2: Vaginal suturing with vicryl 1-0 (USL complex is not visualised and may not be incorporated in the vault).All the patients had a routine follow up on OPD basis after 1 week, 1 month and 1 year.After 1year data was collected over phone & a questioner was filled up and analyzed.Results: There were no case of vault prolapse in either group in the follow up period of 2 to 7 years. There were more complications in the vaginal closure group (vicryl N=62) like spotting and discharge compared to the lap closure group (Vloc N =77). This was statistically significant. (p=0.04). Other secondary outcomes like blood loss was more in larger uterus which took more time for surgery (p=0.001). 18% of the uteri in our study weighted more than 500 grams. BMI, parity and mode of delivery did not influence prolapse rate or complications. Morbidly obese patients (6.4%) were taken up for robotic surgery. Conclusion: There were no cases of vault prolapse in women undergoing hysterectomy without POP in our study. The route of vault suturing and the material used did not show any significant difference in the outcome. Lap closure was associated with significant reduction in cuff infection, vaginal bleeding and granulation formation. A longer follow up may be necessary to corroborate our findings.