Comparison of the efficacy and safety of two advanced vessel sealing technologies in total laparoscopic hysterectomy

Abstract

Aim: Adequately powered, randomized controlled studies evaluating efficacy and safety of advanced bipolar energy devices in gynecologic laparoscopic surgery are very few. We aimed to compare the two most commonly used devices in total laparoscopic hysterectomy. Methods: This randomized controlled trial was carried out in the department of obstetrics and gynecology in an education and research hospital. One hundred thirty-two women who underwent total laparoscopic hysterectomy for benign indications were included. Women with age younger than 18 years, suspected malignancy, stage 3-4 endometriosis and cervical/intraligamentary leiomyoma were excluded. Patients were randomized preoperatively to LigaSure or Articulating Enseal. One experienced surgeon performed all operations. Results: LigaSure was used in 67 patients and Enseal was used in 65 patients. Primary outcomes of the study were operative time (time from start of sealing and transection of the round ligament until completion of colpotomy) and total operative time (time from skin incision to skin closure). Secondary outcomes were intraoperative blood loss (blood lost during operative time period) and perioperative complications. Operative time was significantly shorter in LigaSure group (P = 0.001). Total operative time, intraoperative blood loss and perioperative complications were similar. When two groups were further classified according to uterine weight taking 300 g as cut-off value, operative time was significantly shorter in LigaSure group in both subgroups (P = 0.003 and P = 0.007). Conclusion: LigaSure use in total laparoscopic hysterectomy shortens operative time when compared with Enseal; without an apparent increase in intraoperative blood loss and perioperative complications. On the other side, total operative time remains unaffected.

Comparison of two advanced bipolar tissue sealer/dividers for laparoscopic ovariectomy in dogs: Articulating Enseal G2 versus Ligasure Maryland device

“…However, AENG2 was used in several ovariectomies and other minimally invasive procedures before the start of the present study in order to get used to operating the device. Furthermore, the only two (to the authors knowledge) published studies comparing AENG2 to LMSD both show longer excision times for AENG2 versus LMSD in total laparoscopic hysterectomy in humans [12,14]. Therefore, the difference in ovariectomy duration in the present study is considered a consequence of differences in sealing speed and/or operating features between AENG2 and LMSD.…”

“…These 3 incomplete sealing events all occurred in patients with high fat score, and two happened in the same patient (AENG2 ánd LMSD), indicating that individual patient characteristics may be a risk factor for incomplete tissue sealing rather than bipolar sealing technique. Blood loss was similar between AENG2 and LMSD in total laparoscopic hysterectomy in humans, although a 'mesovarial fat score' was not evaluated in humans [12].…”

“…LigaSure tissue sealer/divider has been considered to set a gold standard in laparoscopic surgery: the device-controlled tissue sealing technique is reliable, fast, easy to use, and has been shown effective to seal blood vessels up to 7mm diameter [1][2][3][4][5][6][7][8][9][10]. Enseal is another leading brand of advanced bipolar tissue sealer/dividers that has previously been shown to be a competitive option compared to LigaSure [11][12][13][14]. Older versions of both devices scored comparably high in terms of seal quality and thermal tissue damage extent while outperforming most other competitors [2,6,10,[15][16][17].…”

Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus: A Comparative Study in Mysuru, South India

“…Another prospective trial was done on 132 patients in Turkey by Yüksel et al who compared the efficacy of LigaSure vs. ENSEAL and found that operative time was significantly more in ENSEAL group; however, no such differences were noted in the current study. 7,9 The size of the uterus is an important factor in the occurrence of intraoperative hemorrhage and postoperative complications during a laparoscopic hysterectomy, especially with uterus weight >500 gm. Subjects with a history of prior gynecologic surgeries have an increased risk of complications due to adhesions.…”

Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis

“…The first applied monopolar instrument was a low-cost and widely available option. Still, its use has progressively decreased, favoring conventional bipolar instruments, which have been developed to reduce energy-related injuries and to provide more efficient vessel coagulation [ 6 ]: the electricity flows between the grasper jaws delimiting the thermal impact in the proximity of the electrodes [ 7 ]. However, the major drawbacks of conventional bipolar instruments are the surgeon-dependent compression of tissues and duration of activation, which may determine incomplete vascular occlusion and the risk of lateral thermal damage.…”