- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05174988
Reducing Postoperative Bleeding After Hysterectomy Via Independent Closure of Vaginal Cuff Angles
Study Overview
Status
Intervention / Treatment
Detailed Description
Hysterectomy is the most common surgical procedure in the United States, with over 600,000 performed annually.1 There has been a dramatic improvement in expected postoperative course secondary to the advancement of minimally invasive gynecologic surgery.2 With the advent of laparoscopy and robotic surgery, even the most complex cases can be successfully performed via a minimally invasive approach. What used to be a major surgery that required a prolonged inpatient stay has become an outpatient procedure where patients are discharged home a few hours after the operation.3 Although the recovery period is shorter than in the past, there are still some postoperative complaints that are relatively common, and can impair quality of life. One of them is postoperative vaginal bleeding. Although this can be a sign of a more serious problem such as vaginal cuff dehiscence, the grand majority of times it is related to granulation tissue in the vaginal cuff that although may be self-limiting, can be bothersome and concerning to patients. Not only does this bleeding impair quality of life, but it's one of the most common reasons for emergency room visits after surgery. Multiple studies have shown that postoperative vaginal bleeding and return to the hospital significantly affect patient satisfaction. 4,5 Anecdotally, bleeding originates from granulation tissue at the angles of the closure, although there hasn't been any studies specifically investigating this. A common approach to laparoscopic cuff closure involves a running barbed suture, with or without separate closure of the lateral angles.6,7 Recently, laparoscopic closure of the vaginal cuff was found to be superior when compared to vaginal closure in terms of vaginal cuff dehiscence8. This RCT also evaluated vaginal cuff bleeding as a secondary outcome, but this was recorded as he presence of bleeding at 3 months after surgery. The closure technique in this study was a running non-barbed suture, without independent suturing of the angles. Although a running suture placed laparoscopically may provide adequate tensile strength throughout the cuff to promote healing, the tension at the corners may be less than at the center when using barbed suture, hence potentially increasing the risk of bleeding. Furthermore, the second angle may be more difficult to access when the remainder of the cuff is re-approximated.
The investigators propose prospectively evaluating if adding separate sutures to the angles of the vaginal cuff before running barbed suture reduces the incidence of patient's perception of bleeding after surgery.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Steven Radtke, MD
- Phone Number: 2177254940
- Email: dr.radtke@gmail.com
Study Contact Backup
- Name: Zuleika Curiel
- Phone Number: 9152155273
- Email: Zuleika.V.curiel@ttuhsc.edu
Study Locations
-
-
Texas
-
El Paso, Texas, United States, 79905
- Texas Tech University Health Scince Center El Paso
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- • Pre-menopausal patients scheduled to undergo hysterectomy via laparoscopic/robotic approach for benign indications (Ages 18-60, who have had at least one menstrual cycle in the last year).
Exclusion Criteria:
Patient's that incur in an intraoperative bowel or urologic injury during the hysterectomy that requires repair. If injury occurs after randomization (during vaginal cuff closure), this will be recorded and reviewed by the study's safety officer
- Patients scheduled to undergo a concomitant vaginal procedure (Mid-urethral sling, anterior/posterior repair)
- Patients scheduled to undergo pelvic floor repair (utero-sacral ligament suspension)
- Patients with known preoperative malignancy
- Patients in which a total hysterectomy is not completed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Angle stitch
If the allocation corresponds to "Angle stitch", surgeon will use 0 polyglactin 910 suture on a tapered needle to place figure of 8 sutures on both (left and right) apexes.
Knot tying technique (intra-corporeal vs extracorporeal) will be up to surgeon preference.
After this is completed, barbed suture will be used to re-approximate the remainder of the vaginal cuff from right to left, backtracking once at the end for reinforcement.
|
Surgeon will use 0 polyglactin 910 suture on a tapered needle to place figure of 8 sutures on both (left and right) vaginal cuff apexes.
|
No Intervention: control
If the subject's group corresponds to "Control group", the surgeon will re-approximate the cuff in a standard fashion, using a running-barbed suture (2-0 V-LOC 90 with tapered needle), starting at the right apex, moving towards the left, and then back-tracking once to further reinforce the closure.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain quantification on 0-10 scale
Time Frame: 10-20 days post intervention
|
Pelvic pain scale from 0-10 assessed at postoperative visit, with 10 representing worse pain imaginable, and 0 representing no pain
|
10-20 days post intervention
|
postoperative bleeding frequency
Time Frame: 10-20 days post intervention
|
Survey regarding postoperative vaginal bleeding- only if they are experiencing bleeding (categorical including Daily | Most days | Infrequent
|
10-20 days post intervention
|
prolonged bleeding
Time Frame: 90-110 days after intervention
|
yes or no if any vaginal bleeding in the last 2 weeks
|
90-110 days after intervention
|
postoperative bleeding volume
Time Frame: 10-20 days post intervention
|
Survey regarding postoperative vaginal bleeding- only if they are experiencing bleeding (categorical including Only when using restroom| Spotting throughout day | More than spotting
|
10-20 days post intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain with sex on a 0-10 scale
Time Frame: 90-110 days after intervention
|
Subjective scoring per patient of pain during intercourse on a scale of 0-10, where 10 is worst pain imaginable and 0 is no pain.
|
90-110 days after intervention
|
ER visits
Time Frame: 90-110 days
|
emergency department visits related to surgery (yes or no)
|
90-110 days
|
Physical functioningSF36
Time Frame: 90-110 days
|
Calculated score Result from SF-36 (Short form-36 health survey) Range 0-100, with 100 representing the maximum of each particular outcome)
|
90-110 days
|
PainSF36
Time Frame: 90-110 days
|
Calculated score Result from SF-36 (Short form-36 health survey) Range 0-100, with 100 representing the maximum of each particular outcome)
|
90-110 days
|
General healthSF36
Time Frame: 90-110 days
|
Calculated score Result from SF-36 (Short form-36 health survey) Range 0-100, with 100 representing the maximum of each particular outcome)
|
90-110 days
|
Role limitations due to physical healthSF36
Time Frame: 90-110 days
|
Calculated score Result from SF-36 (Short form-36 health survey) Range 0-100, with 100 representing the maximum of each particular outcome)
|
90-110 days
|
Operative time
Time Frame: During the surgery. Start time begins when first suture and sewing instruments are in abdomen with the intention of closing vaginal cuff. Stop time is when last suture pertaining to vaginal cuff closure/apex stitches is cut.
|
Vaginal cuff closure time in minutes recorded during the surgery.
Start time begins when first suture and sewing instruments are in abdomen with the intention of closing vaginal cuff.
Stop time is when last suture pertaining to vaginal cuff closure/apex stitches is cut.
|
During the surgery. Start time begins when first suture and sewing instruments are in abdomen with the intention of closing vaginal cuff. Stop time is when last suture pertaining to vaginal cuff closure/apex stitches is cut.
|
Collaborators and Investigators
Investigators
- Principal Investigator: Steven Radtke, MD, Texas Tech University Health and Sciences Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- E22006
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Patient Satisfaction
-
Shaukat Khanum Memorial Cancer Hospital & Research...Enrolling by invitationSatisfaction, Patient | SatisfactionPakistan
-
Acibadem UniversityCompletedPatient Satisfaction | Patient Relations, NurseTurkey
-
Cedars-Sinai Medical CenterTerminated
-
Universitair Ziekenhuis BrusselUnknownPatient Satisfaction | Patient PreferenceBelgium
-
HaEmek Medical Center, IsraelUnknownPatient Satisfaction | Patient Compliance
-
Samsun UniversityRecruiting
-
University of UtahActive, not recruitingPatient SatisfactionUnited States
-
Fatma mahannaCompleted
-
Medical University of ViennaCompletedPatient SatisfactionAustria
-
Ziekenhuis Oost-LimburgCompleted
Clinical Trials on Angle stitch
-
Sohag UniversityCompletedCosmotic Outcome of Distal Penile Hypospidias Repair Using Stitch by Stitch Glanuloplasty Versus TIPDistal Penile HypospadiasEgypt
-
Aesculap AGB.Braun Surgical SAActive, not recruitingInjury of Abdominal WallAustria, Germany
-
Martini-Klinik am UKE GmbHCompletedLymphocele After Surgical ProcedureGermany
-
Hospital del MarCompleted
-
ZSX Medical LLCTerminatedLaparoscopic HysterectomyUnited States
-
Diakonie-Klinikum Schwäbisch Hall gGmbHAesculap AGCompletedSurgical Wound Infection | Dehiscence of Laparotomy WoundGermany
-
University of MalayaCompleted
-
Manchester University NHS Foundation TrustRecruitingSurgery--ComplicationsUnited Kingdom
-
University of California, IrvineCompletedKidney CalculiUnited States