Surgical Best Practice Spotlight: Vaginal Cuff Closure in Minimally Invasive Hysterectomy

Extreme surgical variability exists in minimally invasive hysterectomies

About 600,000 hysterectomies are performed annually in the US, making it one of the most commonly performed surgical procedures, but the surgical practices performed within the procedure are anything but common

For example, a previous Spotlight analysis surfaced that bilateral view of the ureter, a common surgical practice, is only achieved 54%f of the time. That got us thinking, what additional surgical practices should we be looking at in this procedure? 


The answer? Vaginal cuff closure. 

Vaginal Cuff Closure: A Surgical Best Practice

Vaginal cuff closure is a surgical best practice in hysterectomies, and multiple techniques and materials can be used to complete this step. Both a one-layer and two-layer technique are used in clinical practice, however, multiple studies indicate that the two-layer technique is associated with lower rates of complications, including:

    • Infection
    • Hematoma
    • Need for blood transfusion
    • Cuff complications (biggest contributing factor)

We analyzed 1,767 minimally invasive hysterectomies to find out which vaginal cuff closure techniques surgeons are using today. Download the report here.  (It’s free!)

Vaginal cuff dehiscence after hysterectomy

Of the cuff complications noted above, vaginal cuff dehiscence is of particular concern. This refers to the partial or complete separation of previously sutured vaginal cuff edges, a rare but potentially fatal complication following hysterectomy. Importantly, vaginal cuff dehiscence occurs more often with one-layer than two-layer vaginal cuff closure.

Given that the two-layer technique results in decreased rates of vaginal cuff dehiscence, you may think this approach is favored in clinical practice and widely employed by gynecologists. However, our data shows, spoiler alert, that this occurs far less often than bilateral view of the ureter.  

Theator’s Spotlight database compiled 1,767 hysterectomy procedures from 170 surgeons at 5 different health systems to investigate how often a two-layer vaginal cuff closure was achieved.

Curious how vaginal cuff closure techniques vary across health systems? How about within the same health system? Us too. We have answersdownload the report here. 

Surgical Spotlight: Sleeve Gastrectomy

Sleeve Gastrectomy Insights

Obesity is a public health crisis in the US, affecting more than one third of adults. In addition to diet and exercise, medications and surgical procedures are effective obesity treatments for eligible patients, and laparoscopic vertical sleeve gastrectomy is the most commonly performed weight loss surgery in the world.  


Theator’s Surgical Intelligence database has compiled more than 700 sleeve gastrectomy procedures to date from 10 different health systems.


Like all surgical procedures, sleeve gastrectomy has potential complications, including:

  • Bleeding (1.16 – 4.94 %)
  • Leakage (1 – 4%)
  • Acute pancreatitis (1.04%)
  • Venous thromboembolism (0.06 – 2.20%)

30-day readmission occurs in 3.89% of patients following sleeve gastrectomy. The most common reasons for readmission after bariatric surgery include:

  • Nausea/vomiting (14.05%)
  • Abdominal pain (12.14%)
  • Dehydration (10.78%)


Importantly, international best practice guidelines for sleeve gastrectomy note that a lack of standardization can lead to poor outcomes, and if surgeons consistently followed surgical practice techniques, surgical outcomes would be better.


For more sleeve gastrectomy insights, download our procedure spotlight report.

Surgical Practices in Sleeve Gastrectomy

Guidance on surgical practices for sleeve gastrectomy continues to evolve as the body of research on this topic grows. This is excellent news for patients, as the more practices are standardized based on clinical evidence, the better outcomes will be.  

For example, staple line reinforcement may reduce the risk of bleeding along the suture line and other perioperative complications. Notably, there is no current evidence to support one staple line reinforcement technique over another, so techniques vary by surgeon and across institutions. 

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care. 

Curious to know what other insights we’ve seen in our database of gastric sleeve surgeries? Download the full report here.