Energy-Based Vessel Sealing in Vaginal Hysterectomy

Kroft, Jamie; Selk, Amanda

doi:10.1097/aog.0b013e3182324306

Cited by 30 publications

(19 citation statements)

References 15 publications

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“…Some RF-based devices provide electrical current to the vessel followed by an actuated mechanical knife which separates the coagulum into two sealed segments. These devices expedite normally labor-intensive surgical procedures such as lobectomy, 1,2 nephrectomy, 3 gastric bypass, 4-6 splenectomy, 7,8 thyroidectomy, [9][10][11][12][13][14] hysterectomy, 15 and colectomy. [16][17][18][19] However, both electrosurgical and ultrasonic devices have limitations, including the potential for undesirable charring and unnecessarily large collateral thermal damage zones.…”

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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Abstract. Suture ligation of blood vessels during surgery can be time-consuming and skill-intensive. Energy-based, electrosurgical, and ultrasonic devices have recently replaced the use of sutures and mechanical clips (which leave foreign objects in the body) for many surgical procedures, providing rapid hemostasis during surgery. However, these devices have the potential to create an undesirably large collateral zone of thermal damage and tissue necrosis. We explore an alternative energy-based technology, infrared lasers, for rapid and precise thermal coagulation and fusion of the blood vessel walls. Seven near-infrared lasers (808, 980, 1075, 1470, 1550, 1850 to 1880, and 1908 nm) were tested during preliminary tissue studies. Studies were performed using fresh porcine renal vessels, ex vivo, with native diameters of 1 to 6 mm, and vessel walls flattened to a total thickness of 0.4 mm. A linear beam profile was applied normal to the vessel for narrow, full-width thermal coagulation. The laser irradiation time was 5 s. Vessel burst pressure measurements were used to determine seal strength. The 1470 nm laser wavelength demonstrated the capability of sealing a wide range of blood vessels from 1 to 6 mm diameter with burst strengths of 578 AE 154, 530 AE 171, and 426 AE 174 mmHg for small, medium, and large vessel diameters, respectively. Lateral thermal coagulation zones (including the seal) measured 1.0 AE 0.4 mm on vessels sealed at this wavelength. Other laser wavelengths (1550, 1850 to 1880, and 1908 nm) were also capable of sealing vessels, but were limited by lower vessel seal pressures, excessive charring, and/or limited power output preventing treatment of large vessels (>4 mm outer diameter). © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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“…Although previous studies have found a small improvement in postoperative pain with the use of the Ligasure™ device compared with conventional suturing, these studies were small and had methodological limitations 3. It is unclear whether the small difference found in postoperative pain on the evening of surgery in this study is clinically significant.…”

Section: Commentarymentioning

confidence: 63%

“…The study utilised adequate allocation concealment and blinded both patients and outcome assessors. Unfortunately, however, the study was relatively small and, as with many previous studies,3 probably underpowered to demonstrate significant differences in most of their predefined outcomes. The follow-up time of 6 months and the loss to follow-up also limited the findings with respect to quality of life and micturition symptoms.…”

Section: Commentarymentioning

confidence: 86%

Unclear whether energy-based vessel sealing in vaginal hysterectomy is superior to conventional clamping and suturing

Kroft

Selk

2013

Evid Based Med

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Commentary on: Lakeman M, The S, Schellart R, et al. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012;119:1473-82. ContextAlthough vaginal hysterectomy (VH) is the preferred route for treatment of benign disease, 1 it can be technically challenging. Energy-based vessel-sealing devices (EBVSD) allow for rapid sequential tissue and vessel sealing and transection of the vascular pedicle in one handheld tool. 2 A recent meta-analysis suggested that EBVSDs may decrease operating time, blood loss and hospital stay, but results were limited due to the quality of included studies. 3 MethodsThis multicentre randomised controlled trial of 100 women, comparing the Ligasure™ bipolar vessel-sealing device with conventional suturing for VH was performed in eight academic centres in the Netherlands. The primary objective of the study was to compare the two surgical techniques with respect to postoperative pain, recovery and micturition symptoms and the secondary objective was to evaluate the difference in costs.Postoperative pain was measured for 6 weeks using a daily diary visual-analogue scale (VAS). Postoperative micturition symptoms and quality of life were measured using four different validated questionnaires 6 months postoperatively. Costs were calculated from a healthcareprovider perspective over a 6-week time horizon. FindingsPatients in the conventional suturing arm were older, on average, by 4 years and had more comorbidities due to imbalance in randomisation. The only statistically significant difference in any of the parameters measured was less postoperative pain in the EBVSD arm on the evening of surgery (5.7 vs 4.5 on a scale of 0-10, p=0.03). Other differences that were not statistically significant were an average operative time that was less using the EBVSD (59.7±28.3 min vs 71.3±27.0 min, p=0.05) and the difference in total costs (€3188 for EBVSD vs €2943 for conventional suturing). There was a 25% loss to follow-up at the end of the study. CommentaryThe authors of this study attempt to answer some important questions that have previously been unanswered, including whether or not the use of EBVSD compared with conventional suturing for VH can improve patient-centred outcomes such as postoperative pain and quality of life.It is also the first study that has attempted to explore additional costs that may be associated with use of EBVSD. The study utilised adequate allocation concealment and blinded both patients and outcome assessors. Unfortunately, however, the study was relatively small and, as with many previous studies, 3 probably underpowered to demonstrate significant differences in most of their predefined outcomes. The follow-up time of 6 months and the loss to follow-up also limited the findings with respect to quality of life and micturition symptoms.In addition, the difference in operating time of borderline statistical significance may have resulted from including surgeons with various levels of surgi...

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“…Accordingly, a few authors suggested the use of advanced electrosurgical instruments that provide the ability to rapidly and sequentially seal vessels and coagulate and transect pedicles with a tool manipulated by one hand. Previous studies showed such instruments adapted to vaginal surgery from laparoscopic practice were suitable alternatives to conventional suturing techniques and had similar safety profiles [7,12,13]. To our knowledge, no studies have yet compared the surgery-related outcomes of EBVS system and conventional suture ligation technique only focusing on the morbidly obese patients undergoing VH.…”

Section: Discussionmentioning

confidence: 97%

Safety and efficacy of using advanced electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients: a retrospective cohort analysis

et al. 2017

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Objectives: To assess the safety and efficacy of electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients. Material and methods:A total of 105 morbidly obese patients who underwent vaginal hysterectomy due to benign gynecologic pathologies between January 2010 and April 2017 were included in the study. Patients were divided into two groups according to whether conventional suture ligation technique (n = 64) or electrosurgical bipolar vessel sealing (n = 41) were used during vaginal hysterectomy. The surgical procedure was performed with the same technique in both study groups. The primary outcomes were duration of surgery and estimated blood loss. The secondary outcomes were intra-operative complications and post-operative complications. Results:The duration of surgery and estimated blood loss in the vessel sealing group was significantly less than in the conventional suture group (p < 0.05). No significant difference was present between the two groups in the rate of intra-operative and post-operative complications. Conclusions:The primary outcome of our study is that the EBVS system can be used equally and even more effectively in some aspects; and as safe an alternative approach to conventional suture ligation technique during vaginal hysterectomies performed specifically on morbidly obese patients with reduced operation times and blood loss, and without increasing the complication rates.

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Energy-Based Vessel Sealing in Vaginal Hysterectomy

Abstract: This review suggests that energy-based vessel sealing devices may decrease operating time, blood loss, and hospital stay. There was no difference in complication rate and no studies investigated mortality or quality of life.

Cited by 30 publications

References 15 publications

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Unclear whether energy-based vessel sealing in vaginal hysterectomy is superior to conventional clamping and suturing

Safety and efficacy of using advanced electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients: a retrospective cohort analysis

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