Background and Objectives:The purpose of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors for secondary hemorrhage after total laparoscopic hysterectomy.Methods:All women who underwent total laparoscopic hysterectomy at Paul's Hospital between January 2004 and April 2012 were included in the study. Patients who had bleeding per vaginam between 24 hours and 6 weeks after primary surgery were included in the analysis.Results:A total of 1613 patients underwent total laparoscopic hysterectomy during the study period, and 21 patients had secondary hemorrhage after hysterectomy. The overall cumulative incidence of secondary hemorrhage after total laparoscopic hysterectomy was 1.3%. The mean size of the uterus was 541.4 g in the secondary hemorrhage group and 318.9 g in patients without hemorrhage, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 13 days. Packing was sufficient to control the bleeding in 13 patients, and 6 patients required vault suturing. Laparoscopic coagulation of the uterine artery was performed in 1 patient. Uterine artery embolization was performed twice in 1 patient to control the bleeding.Conclusions:Our data suggest that secondary hemorrhage is rare but may occur more often after total laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues, which causes more tissue necrosis and devascularization than sharp culdotomy in abdominal and vaginal hysterectomies, is not clear. A large uterus size, excessive use of an energy source for the uterine artery, and culdotomy may play a role.
Context: Hysterectomy is the most commonly performed gynecological procedure around the world. Hemostasis is of major concern in an enlarged uterus as chances of hemorrhage are more. New laparoscopic vessel sealing devices have been developed for laparoscopic tissue dissection and vessel sealing. In this study, an ALAN vessel sealer, an indigenous electrothermal bipolar vessel sealing device, is compared with ENSEAL device with respect to safety, efficacy, and perioperative outcomes in laparoscopic hysterectomy for a large uterus. Aims and objectives: This study aimed to determine the efficacy and safety of electrothermal bipolar vessel sealer (ALAN vessel sealer) vs ENSEAL in total laparoscopic hysterectomy (TLH) for a large uterus. Materials and methods: This prospective randomized case-control study included 100 women who underwent TLH for a large fibroid uterus. Of them, 50 women underwent TLH using ALAN vessel sealer, and the remaining 50 using ENSEAL. Efficacy, safety, and perioperative outcomes of both the groups were compared. Statistical analysis: Statistical analysis was done using SPSS version 16.0 software. For evaluating continuous variables and discrete variables, independent T-tests, and Chi-square tests, respectively, were used. Results: Duration of surgery in ALAN vessel sealer group was 56.90 ± 12.45 minutes and in ENSEAL group was 57.25 ± 13.54 minutes (p = 0.9) and mean blood loss in group A and group B was 111.40 ± 22.32 and 107.84 ± 20.33 mL, respectively ( p = 0.4), both of the data were not statistically significant. No significant differences were noticed in the demographic characteristics, intraoperative, and postoperative complications between the two groups. Conclusions: The ALAN vessel sealer is safe and as efficient as ENSEAL in decreasing blood loss and operative time when laparoscopic hysterectomy is performed for an enlarged uterus. It is cost-effective and a promising instrument for TLH in developing countries.
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