Design: Retrospective cohort

Setting: N/A

Patients or Participants: Women who underwent TLH or RATLH with a minimally invasive gynecologic surgeon over a 6-year period

Interventions: Two patient cohorts were evaluated: 1) Patients with post-operative vaginal cuff check approximately 6 weeks post-operatively and 2) Patients who did not have a cuff check, with the majority following up entirely virtually as a result of a shift in practice during the COVID-19 pandemic.

Measurements and Main Results: A total of 703 patients were identified. 216 (30.7%) presented for in-person cuff check and 487 (69.3%) did not. Within the no cuff check group, 287 (58.9%) had all virtual follow-up. There were no statistically significant differences between groups with regard to age, race, BMI, parity, smoking status, menopausal status, and co-morbid conditions that are risk factors for VCD such as diabetes, immunosuppression, or connective tissue disease.

There was no statistically significant difference in VCD among groups. 9 patients had VCD (1.28%), 2 who had a cuff check (0.93%) and 7 who did not (1.4%, p=0.73). Median time to VCD was 70.0 [27.5-114.0] days. Both patients in the cuff check group with VCD had appropriately healing cuffs at their post-operative exam.

No VCD were identified in asymptomatic patients with routine exam. As a result of cuff check, 5 (2.3%) patients received silver nitrate, 1 (0.47%) was prescribed vaginal estrogen, and 6 (2.8%) continued pelvic rest for 2 weeks. There was no difference in points of contact for post-operative symptoms, with both groups having a median of 0 points of contact [0-1.0], (p=0.778).

Conclusion: Vaginal cuff exam does not affect or negate the risk of future VCD. Virtual follow-up for asymptomatic patients may be appropriate after hysterectomy.