Comparative Analysis of Peri-Operative Outcomes Following Total Laparoscopic Hysterectomy with Conventional Bipolar-Electrosurgery versus High-Pressure Pulsed LigaSure Use

Abstract

Objectives: Quick and effective hemostasis is essential for a successful laparoscopic surgery. Hence, it is of utmost importance for laparoscopic surgeons to understand the various available and emerging energy sources to tailor their use according to their properties and surgical requirement. The aim of this study was to compare LigaSure, an advanced bipolar versus conventional bipolar in total laparoscopic hysterectomy, with respect to operating time, mean blood loss, mean reduction in hemoglobin, intraoperative, and postoperative complications, and duration of prospective hospital stay. Materials and Methods: It was a randomized controlled study. One hundred and twenty patients scheduled for elective hysterectomy for any benign indication were randomly allocated to two groups namely, conventional bipolar group and LigaSure group. Patients with a history of ≥3 laparotomies, uterine size >20 weeks were excluded. Total laparoscopic hysterectomy with bilateral salpingectomy/salpingo oophorectomy was done in all the patients and endpoints were evaluated. Results: All the recruited participants ( n = 120) achieved study endpoints. There was statistically significant difference in the meantime to dissect adnexal ligaments, primary and total operating time (for adnexal ligaments: Conventional bipolar-9.44 min vs. LigaSure-7.05 min; P = 0.000) (Primary: Conventional bipolar-97.03 min vs. LigaSure 74.39 min; P = 0.000) (Total: 142.5 min vs. 136.37 min P = 0.002). Mean blood loss (145 ml vs. 141.67 ml; P = 0.846), mean reduction in hemoglobin (0.802 versus 0.752; P = 0.484) and duration of postoperative stay (2.54 days vs. 2.32 days; P = 0.128) were comparable ( P > 0.05). None of the participants suffered from any major complication during the surgery or in the postoperative recovery period. Conclusion: With an ability to effectively reduce operating time, LigaSure is a safe and efficient instrument for laparoscopic hysterectomy.

Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens’ Eligibility for Histological Examination

“…Because we used electrosurgical instruments such as monopolar forceps, ultrasonic scalpels, and advanced bipolar instruments during colpotomy,[ 14 ] heat damage can be considered another possible cause of epithelial detachment. However, thermal artifacts as shown by histological alteration in the epithelium and connective tissue were confined to the resected portion of the vagina, and most desquamated areas did not show thermal artifacts in all cases.…”

Simple Enterolysis Techniques during Minimally Invasive Gynecologic Surgery

“…Electrosurgery expedites surgery, ensures hemostasis, and is safe, which is especially challenging while operating in self-contained pelvic spaces. [ 7 ] Dissections should be directed distal to the bowel serosa with adequate bowel retraction for protection. Adhesions between bowel loops should be lysed to restore its anatomic integrity.…”

Vaginal Vault Closure Following Total Laparoscopic Hysterectomy: Laparoscopic versus Conventional Technique – A Comparative Study

“…In a study done in 2016, the perioperative outcomes following laparoscopic hysterectomy using different energy sources were studied that detailed its cautious use to avoid unintended thermal damage to the surrounding tissues. [ 10 ]…”