Dr. Kirtan Vyas is an experienced gynecologist who has performed numerous total laparoscopic hysterectomies (TLHs). He discusses that vaginal cuff suturing is a critical component of TLH but can be technically challenging to perform laparoscopically due to required advanced surgical skills and long learning curve. Transvaginal cuff closure is an easier, safer, and more effective alternative that significantly reduces operative time without needing advanced laparoscopic skills. Complication rates like vault dehiscence and infection are also lower with transvaginal closure compared to laparoscopic suturing.

1. •VAGINAL CUFF SUTURING
IN TLH
DR. KIRTAN VYAS
M. S. –OB/GY
AHMEDABAD

2. •M.S.-OB/GY , Gold Medalist, Guj. Uni., Ahmedabad
•Gujarat Public Service Commission(GPSC) first for post of
Assistant Professor
•Fellow in Gynec Endoscopy(Mumbai),USG (FOGSI)
•Publications in various International Journals
•Faculty at many State and National Conferences
•Local Jt. Secretary of SOGOG, 2015
•Organising Secretary for the First Rajkot Obstetrics and Gynec Society
Annual Conference 2015
•Organizing secretary for the West Zone Yuva Fogsi 2016,Rajkot
Experience as an Assistant Professor at P.D. U. Medical College, Rajkot
for 4 years
Recipient of West Zone Yuva Fogsi Oration, Bhubaneswar, AICOG 2018
Presently at Sevak Maternity & Surgical Hospital, Ahmedabad
DR. KIRTAN VYAS
M.S.(OB/GY)

3. ERA OF LAPAROSCOPIC
HYSTERECTOMY
• Hysterectomy – one of the
commonest surgeries
worldwide
• Laparoscopy has transformed
this procedure drastically
• Vaginal cuff closure is a
critical component in
Hysterectomy with many
variations in surgical
technique and materials

4. TECHNIQUES FOR VAGINAL
CUFF CLOSURE
Laparoscopic suturing
– Intra corporeal/ Extra corporeal
– Continuous/ Interrupted
Trans vaginal suturing
Wide variations between
individuals and institutions

5. LAPAROSCOPIC VAULT SUTURING- IS
IT WORTH EVERYTIME AND FOR
EVERYONE??!!
A biomechanically complex procedure
The most challenging part due to technical
aspects of laparoscopic suturing techniques
Requirement of advanced surgical skills
long learning curve
time-consuming process
In a questionnaire study, surgeons declared
they are performing TLH less than AH or VH
because of technical difficulties with TLH!!

6. • Bacterial contamination is leading cause of
febrile morbidity and of infectious
complications
• It is worth noting that even in the absence of
infection, the vaginal cuff is subject to the
formation of granulation tissue that can
generate persistent discharge and
postoperative bleeding
OTHER ASPECTS OF VAGINAL
CLOSURE

7. • A STRIKING INCREASE IN THE
INCIDENCE OF VAGINAL CUFF
DEHISCENCE AFTER LAPAROSCOPIC
SUTURING….??
Technical difficulty of the procedure
Complexity of performing the suturing
Insufficient quantity of tissue incorporated
in the suturing
Inserting sutures too close to surgical area
(<1 cm) due to misleading effect of
laparoscopic magnification

13. CONCLUSION- WHY TO
COMPLICATE A SIMPLE
PROCEDURE??!!
• Trans vaginal cuff closure is easy, safe and
effective in TLH
• Significantly reduced operative time and
advanced surgical skill
• Vault dehiscence, infection, hematoma and
re-intervention rates are lower compared to
laparoscopic suturing

14. MY THANKS TO MY SUPPORT SYSTEM
MY MENTORS, UOGS , AUDIANCE