The study population is comprised women at reproductive and premenopausal ages whom refer to gynecology clinic in Rasool-e Akram Tertiary and a private Hospitals in Tehran. The candidates will be select for total laparoscopy hysterectomy and bilateral salpingo-oophorectomy. Any vaginal infection that reveals by examination will be treated.
The exclusion criteria's are: patients with recent history like smoking, diabetes, mellitus, immune deficiency, vascular diseases, coagulation disorders, consuming corticosteroids, abnormal Pap smear and suspicious to cancer and menopausal women.
Patients who have inclusion criteria's after filling of consent form, by using the randomization table randomly assigned to two groups: 1) conventional and 2) new techniques for vaginal cuff closure. Patients were not aware of the type of intervention they performed on them.
After placement of 11 mm umbilical trocar and two 5 mm lateral and 11 mm suprapubic trocars, under general anesthesia, every bites are cut by ligasure or bipolar and scissors.
After the securing the angle of incision, a full thickness needle bite is taken suturing 1 cm away from the margin of the incision and coming out at 0.5 cm from the edge of the vaginal epithelium. After then, the entering perform at 0.5 cm to the vaginal epithelium of opposite edge and come out 1 cm away from of the margin of the incision in oblique fashion.
A superficial bite is taken encircling the outer margins without biting vaginal epithelium. Base of length of the cuff, 3-5 stiches are running the same fashion. The patients will be discharge after 48 hours and educate for amount of vaginal bleeding.
If the 1/4, 1/2 or entire of the pad is being wet, the volume of bleeding is classified to low, moderate and severe. The patient will be follow in three month by phone call. Every week for six weeks and then biweekly.
If the patients have any severe vaginal bleeding, profuse or malodor vaginal discharge, fever and chills, it is recommended to refer to our GYN clinic.