Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

Abstract

Objective To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy.Design Randomised controlled trial.Setting Eight teaching hospitals in the Netherlands.Population One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse.Methods Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery.Main outcome measures Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs.Results The evening after surgery, women in the vessel-sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0-10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 €, P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used.Conclusion Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.Keywords Costs, electrosurgical bipolar vessel sealing, Ligasure, pain score, vaginal hysterectomy.Please cite this paper as: Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial.

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy

“…In our cohort, operative time was longer in the LSJI arm as compared to the arm of the conventional method of ligation in hysterectomy (p:0.016). This result is in line with the results of Lauroy A et al and Lakeman et al 15,19 In our opinion, the longer operative time in LSJI surgeries results from the uncontrolled minor bleedings and the need for additional sutures. In other studies, on contrary, a shorter duration of operation was counted when LSJI is employed than when conventional methods were used.…”

Randomized controlled trial of thermal balloon ablation versus vaginal hysterectomy for leiomyoma-induced heavy menstrual bleeding

“…Soysal et al [10] showed a linear pain score at 12 hours (3.1 ± 1.7) for both TBA and roller ball ablation, and a similar observation was made by Sesti et al [18], who reported that postoperative pain intensity at 24 hours was significantly lower in women treated with TBA than in those who underwent laparoscopic supracervical hysterectomy. Lakeman et al [21] compared the effects of electric bipolar vessel sealing and conventional suturing on postoperative pain and reported less pain on the evening after vessel sealing surgery (4.5 vs 5.7), with subsequent similar pain scores. In the present study, the conventional method of vaginal hysterectomy was used, with a postoperative pain score of 6.7 being observed on the evening of the surgery.…”

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

“…We read with much interest the paper by Lakeman et al ,. published in the November 2012 issue of BJOG .…”