Suture versus vessel sealer in vaginal hysterectomy: an observational study

Abstract

Background: Vaginal route is considered to be the method of choice for removal of uterus and, in the absence of gross pelvic disease, can be carried out in most patients. Recent studies have shown that less than one-third of hysterectomies are performed vaginally. This could be due to technical difficulties occurring while operating in the narrow surgical field. This study was taken up to find out the easier alternatives in securing pedicles by using Electrosurgical Bipolar Vessel Sealer in Vaginal Hysterectomy.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over a period of one year i.e. July 15 to June 16. A total of 62 patients posted for vaginal hysterectomy for benign conditions were enrolled after informed consent. Results were recorded under headings of procedure time (min), blood loss (ml), major intra-operative complications and post operative complications, post-operative pain (on VAS) and duration of hospital stay.Results: Mean procedure time in suture method was found to be 55.66min, whereas, in sealer group it was 27.75 min. Mean blood loss in the sealer group was 83.78ml, while, in suture group it was 156.62ml. Mean pain score on Visual Analogue Scale on POD 1 was 8.44±1.1522 for suture group and 6±1.325 for sealer group. Mean pain score on POD2 in sealer group was 3.48±1.325 and in the suture group it was 5.31±1.754 (P<0.0001). Mean pain score on POD3 in suture group 2.82±0.508, in sealer group it was 1.0909±0.608 (P<0.0001). Pain scores, thereafter, did not differ significantly. Mean length of stay in suture group is 10.71 days (suture group) versus 5.3 days (sealer group). Blood loss >200ml was observed in 29.03% of suture cases, none in the sealer group (P-value .0006). Labial burn occurred in 2 out of 32patients in sealer group.Conclusions: From above study, we conclude that bipolar vessel sealer has shown a significant reduction in intra-operative blood loss, procedure time, immediate post-operative pain (POD1,2&3), mean length of stay in hospital, major intra-operative blood loss>200ml which was found in significant number of cases in suture group.

Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study

“…As expected, similar to past reports [12] , [13] , this analysis indicated the advantage of vNOTES-H regarding operation time without a significant increase in blood loss. This advantage may be derived from the characteristics of this surgical procedure in which uterine arteries are cut together with cutting cardinal ligaments by using LigaSure™ without exposure and ligation of uterine arteries, such as with VTH with vessel-sealing devices [23] , [24] . The suture method, in which the vaginal wall was sutured from the outside of the vagina, might also contribute to the short time operation.…”