Electrosurgical bipolar vessel sealing during vaginal hysterectomy.

OBJECTIVE: To compare electrosurgical bipolar vessel sealing (EBVS) with traditional suturing during vaginal hysterectomy. METHODS: In a randomized controlled trial involving 68 women undergoing vaginal hysterectomy for benign disease, 37 procedures were performed using EBVS and 31 using traditional suturing. The end points were procedure time, blood loss, number of ligatures used, postoperative pain score, and number of days in hospital. RESULTS: The procedure duration was shorter using EBVS (median duration, 32 vs. 40 min; P=.0003), with fewer ligatures (1 vs. 7; P<.0001) and less pain (median score, 4 vs. 6; P<.0001). There were no significant differences regarding blood loss (median, 100 vs. 160 mL; P=.36) and days in hospital (median, 2 vs. 2; P=.03). CONCLUSION: The EBVS system provided advantages over traditional suturing with regard to procedure time, number of ligatures used, and postoperative pain score.     

Abdominal vs vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction

Objective: To compare the short-term results of the quality of life and satisfaction of patients submitted to total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) for benign uterine disease. Methods: Women referred for hysterectomy for uterine myoma were randomized to TAH (n=30) or VH (n=30). The exclusion criteria were uterine prolapse, indication associated surgical procedures and uterine size ≥300 cm³. After a month, follow-up questionnaires had a response rate of 100%, and consisted of an interview with application of SF-36 questionnaire (functional capacity, physical aspect and pain) and evaluation of satisfaction rate. Results: There were no differences in the patients’ mean age, parity, body mass index, preoperative hemoglobin levels and uterine size between groups. Lower postoperative quality-of-life scores were found in the TAH group when compared to the VH group in functional capacity (P=0.002), physical aspect (P=0.008) and pain (P=0.002). The general satisfaction rate with the surgery was similar in the two groups of patients (P=0.147). However, a higher rate of patients submitted to VH would choose the same therapeutic modality (65.5 vs 90%; P=0.021). Conclusions: A better postoperative quality of life (functional capacity, physical aspect and pain) and higher satisfaction rate was found in the VH when compared to TAH.     

Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: A randomised controlled trial

Objective

To assess the efficacy of electrosurgical bipolar vessel sealing using the LigaSure^® system during vaginal hysterectomy in comparison with conventional suture ligation method.

Study design

103 patients undergoing vaginal hysterectomy for benign conditions were randomised to either LigaSure^® or Suture groups. Each group was divided into two subgroups according to the degree of surgical difficulty.

Results

Participants in the LigaSure^® had shorter procedure time (52.5 min vs. 90 min; p < 0.001) and less blood loss (230 ml vs. 360 ml; p < 0.001). Complication rates were not statistically different between the two groups. The advantage of the LigaSure^® system in reducing the operative blood loss was more pronounced in the more difficult procedures.

Conclusion

The LigaSure^® system reduces the operating time (by reducing pedicle-securing time) and blood loss without increasing the post-operative complication rates of vaginal hysterectomy. This beneficial effect was found to be more pronounced in difficult procedures.     

Postoperative pain after hysterectomy through vaginal routes using electro surgical bipolar vessel sealing versus conventional suture ligature

OBJECTIVES: The purpose of the study was to compare the postoperative pain of patients who had a hysterectomy through vaginal route according to the process of binding: wire or electrosurgical bipolar vessel sealing. PATIENTS AND METHODS: Retrospective study carried out in the 60 last patients who underwent a hysterectomy by vaginal route for a benign pathology in the gynaecological service of surgery of the CHI Poissy-Saint-Germain-en-Laye until March 2006. Among these patients, 32 had profited from a binding by wire and 28 of the electrosurgical bipolar vessel sealing. The studied criteria were the post-operative pain, total morphine consumption and the durations of the analgesic treatment, the hospitalisation and intervention time. RESULTS: The postoperative pain in the first 24 hours was twice lower using thermofusion; it was valid in immediate post-operative period and after 24 hours. In addition, total morphine consumption was also significantly lower using thermofusion. DISCUSSION AND CONCLUSION: This pilot study shows that the electrosurgical bipolar vessel sealing allows a reduction in the pain into the immediate postoperative period. Other prospective and randomised studies would allow it and conclude on the duration of hospitalisation, the quality of life from the patients and the cost in terms of public health.     

Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy

OBJECTIVE: To compare blood loss and procedure time of vaginal hysterectomy using an electrosurgical bipolar vessel sealer versus using sutures. METHODS: Sixty patients scheduled for vaginal hysterectomy in a single surgical practice were randomized to either electrosurgical bipolar vessel sealer or sutures as the hemostasis technique. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the anesthesia service. Statistical methodology included the Student t and Wilcoxon rank-sum tests, and all comparisons were two tailed, with P <.05 considered significant. RESULTS: Use of an electrosurgical bipolar vessel sealer resulted in shorter procedure times: The mean procedure time in the electrosurgical bipolar vessel sealer arm was 39.1 minutes (range 22-93) versus 53.6 minutes (range 37-160) for the suture arm (P =.003). Mean estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer: 68.9 mL (range 20-200) versus 126.7 mL (range 25-600) for the suture arm (P =.005). Complication rate and length of stay did not differ by hemostasis technique. Seventy-eight percent of all cases were outpatient. CONCLUSION: Electrosurgical bipolar vessel sealer is an effective alternative to sutures in vaginal hysterectomy, resulting in significantly reduced operative time and blood loss.     

Improved hemostasis with plasma kinetic bipolar sealing device in the vaginal steps of laparoscopic-assisted vaginal hysterectomy

Objective

During the vaginal steps of laparoscopic-assisted vaginal hysterectomy (LAVH), excessive bleeding occurs if the vascular pedicles are not securely clamped. Accordingly, this study investigates if an advanced bipolar sealing device (PlasmaKinetics [PK] Sealer), compared to conventional sutures, could improve the efficacy and safety in the vaginal steps of LAVH.

A randomized study of total abdominal, vaginal and laparoscopic hysterectomy.

OBJECTIVES: To evaluate operative time, blood loss and inflammatory response in patients submitted to hysterectomy. METHODS: Sixty patients referred for hysterectomy were prospectively randomized to total abdominal hysterectomy (n=20), vaginal hysterectomy (n=20), or laparoscopic hysterectomy (n=20). The operative time, blood loss (variation in erythrocyte and hemoglobin) and inflammatory answer (CRP and interleukin-6 dosages) were compared by using Kruskal-Wallis, Dunn non-parametric test and variance analysis with repeated measurements. RESULTS: Operative time was shorter for vaginal hysterectomy, and there was no significant difference between total abdominal hysterectomy and laparoscopic hysterectomy. Reduction in erythrocyte and hemoglobin was more noticeable after vaginal hysterectomy, followed by total abdominal hysterectomy and laparoscopic hysterectomy. CRP levels increased steadily from vaginal hysterectomy to laparoscopic hysterectomy and then to total abdominal hysterectomy. The increase in interleukin-6 was substantially higher in total abdominal hysterectomy, whereas no difference was noted between vaginal and laparoscopic hysterectomy. CONCLUSIONS: Vaginal hysterectomy presents superior results in terms of operative time and inflammatory response when compared with total abdominal and laparoscopic hysterectomy and it should be the first option for hysterectomy. Laparoscopic hysterectomy should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.     

Comparison of LigaSure™ tissue fusion system and a conventional bipolar device in hysterectomy via natural orifice transluminal endoscopic surgery (NOTES): A randomized controlled trial

Objective

To evaluate the efficacy and effectiveness of applying LigaSure? Tissue Fusion System in hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES) in comparison with using the conventional bipolar device.