To examine the safety, complication rate, and trend of using the V-Loc™ unidirectional barbed suture in closure of the vaginal cuff during total laparoscopic hysterectomy compared to standard suture methods. Retrospective cohort study. Large, urban, tertiary-care academic hospital. Patients who underwent a total or robotic-assisted laparoscopic hysterectomy by members of a minimally invasive gynecologic surgery division from April 2010 to January 2012. Use of a V-Loc unidirectional barbed suture for laparoscopic vaginal cuff closure. A total of 537 patients were identified: 322 (60%) utilized a V-Loc unidirectional barbed suture and 215 (40%) a standard suture, either polysorb or PDS, for closure of the vaginal cuff. Patients who had closure of the vaginal cuff with a bidirectional barbed suture were excluded. Demographic, clinical and surgical characteristics were overall similar between the two groups. Complications also did not differ significantly. The rates of vaginal cuff dehiscience (1.2% vs. 0.5%), postoperative vaginal bleeding requiring treatment (2.5% vs. 1.4%), and postoperative infection including cellulitis (4.0% vs. 1.9%) were similar between the V-loc and standard suture groups (p>0.05). There was increasing use of the V-Loc suture in closure of the vaginal cuff over time: 27% utilized a V-Loc suture in the first 10 months of the study time period (April 2010 to February 2011), which increased to 77% during the second 10 months (March 2011 to January 2012). We are the first to describe the safety, complication rate, and trend of a unidirectional barbed suture in closure of the vaginal cuff during total laparoscopic hysterectomy. Use of the V-Loc unidirectional barbed suture is a safe and potentially time-saving alternative to closure of the vaginal cuff closure with a complication rate similar to that of a standard suture.

Excision of an ovarian remnant often requires an extensive retroperitoneal dissection. This video presents two cases of laparoscopic excision of ovarian remnants that required ligation of the uterine artery at its origin. These cases clearly demonstrate the retroperitoneal pelvic anatomy, including the internal iliac artery giving rise to the uterine artery, the ureter, and the pararectal and paravesical spaces. This video is intended to review the pertinent anatomy that is vital to successfully completing the retroperitoneal dissection, and to demonstrate the techniques necessary for laparoscopic excision of an ovarian remnant.