Comparative Characteristics of Hemostasis During Vaginal Hysterectomy
https://doi.org/10.25207/1608-6228-2019-26-6-61-69
Abstract
Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.
Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).
Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p < 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p < 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p < 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p < 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.
Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study
About the Authors
Andrei N. Plekhanov
I.P. Pavlov First St. Petersburg State Medical University
Russian Federation
Russian Federation
Andrey N. Plekhanov — Dr. Sci. (Med.), Prof., Department of Obstetrics, Gynaecology and Neonatology
6–8 L’va Tolstogo str., Saint Petersburg, 197022
Vitalii F. Bezhenar
I.P. Pavlov First St. Petersburg State Medical University
Russian Federation
Russian Federation
Vitaly F. Bezhenar — Dr. Sci. (Med.), Prof., Head of the Department of Obstetrics, Gynaecology and Neonatology
6–8 L’va Tolstogo str., Saint Petersburg, 197022
Tat’yana A. Epifanova
I.P. Pavlov First St. Petersburg State Medical University
Russian Federation
Russian Federation
Tatyana A. Epifanova — Postgraduate Researcher, Department of Obstetrics, Gynaecology and Neonatology
6–8 L’va Tolstogo str., Saint Petersburg, 197022
Fedor V. Bezhenar
St. Petersburg Clinical Hospital of the Russian Academy of Sciences
Russian Federation
Russian Federation
Fedor V. Bezhenar — Obstetrician-Gynecologist, Surgical Department
72-A Toreza ave., St. Petersburg, 194017
References
1. Falcone T., Walters M. Hysterectomy for benign disease. Obstet. Gynecol. 2008; 111(3): 753–767. DOI: 10.1097/AOG.0b013e318165f18c
2. Adamyan L.V., Sukhikh G.T., editors. New technologies fordiagnosis and treatment of gynecologic diseases. Moscow: MEDI ekspo; 2010. 304 р. (In Russ.).
3. Zubke W., Hornung R., Wässerer S., Hucke J., Füllers U., Werner Ch., Schmitz P., Lobodasch К., Hammermüller U., Wojdat R., Volz J., De Wilde R.L., Wallwiener D. Bipolar coagulation with the BiClamp® forceps versus conventional suture ligation: a multicenter randomized controlled trial in 175 vaginal hysterectomy patients. Gynecol. Obstet. 2009; 280(5): 753–760.
4. Popov A.A., Ramazanov M.R., Fedorov A.A., Slobodyanyuk B.A. Vaginal hysterectomy using electroligation with bipolar coagulation forceps Biclamp. Onkoginekologiya. 2012; 3: 17–21 (In Russ., English abstract).
5. Zubke W., Krämer B., Hornung R., Wallwiener D. Use of the BiClamp (a bipolar coagulation forceps) in gynecological surgery. Gynecol. Surg. 2007; 4(1): 9–16. DOI: 10.1007/s10397-006-0262-5
6. Hefermehl L.J., Largo R.A., Hermanns T., Poyet C., Sulser T., Eberli D. Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery. BJU Int. 2014; 114(2): 245–252. DOI: 10.1111/bju.12498
7. Pogorelić Z., Katić J., Mrklić I., Jerončić A., Šušnjar T., Jukić M., Vilović K., Perko Z. Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: comparison of the harmonic scalpel (Ultracision), bipolar coagulation (LigaSure), and thermal fusion technology (MiSeal). J. Surg. Res. 2017; 212: 101–107. DOI: 10.1016/j.jss.2017.01.014
8. Jaiswal A., Huang K.-G. Energy devices in gynecological laparoscopy — archaic to modern era. Gynecol. Min. Inv. Ther. 2017; 6(4): 147–151. DOI: 10.1016/j.gmit.2017.08.002
9. Liang J., Xing H., Chang Y. Thermal damage width and hemostatic effect of bipolar electrocoagulation, LigaSure, and Ultracision techniques on goat mesenteric vessels and optimal power for bipolar electrocoagulation. BMC Surg. 2019; Article number: 147. DOI: 10.1186/s12893-019-0615-4
10. Zhu Q., Ruan J., Zhang L., Jiang W., Liu H., Shi G. The study of laparoscopic electrosurgical instruments on thermal effect of uterine tissues. Arch. Gynecol. 2012; 285(6): 1637–1641. DOI: 10.1007/s00404-011-2207-0
Review
For citations:
Plekhanov A.N., Bezhenar V.F., Epifanova T.A., Bezhenar F.V. Comparative Characteristics of Hemostasis During Vaginal Hysterectomy. Kuban Scientific Medical Bulletin. 2019;26(6):61-69. (In Russ.) https://doi.org/10.25207/1608-6228-2019-26-6-61-69
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