Volume 119, Issue 12 p. 1473-1482
General gynaecology

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

MME Lakeman

MME Lakeman

Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands

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S The

S The

Department of Obstetrics and Gynaecology, Antonius Hospital, Nieuwegein, the Netherlands

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RP Schellart

RP Schellart

Department of Obstetrics and Gynaecology, Kennemer Gasthuis, Haarlem, the Netherlands

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V Dietz

V Dietz

Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands

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JF ter Haar

JF ter Haar

Department of Obstetrics and Gynaecology Tweesteden Hospital, Tilburg, the Netherlands

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A Thurkow

A Thurkow

Department of Obstetrics and Gynaecology, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands

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PC Scholten

PC Scholten

Department of Obstetrics and Gynaecology, Diakonessenhuis Utrecht, the Netherlands

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MGW Dijkgraaf

MGW Dijkgraaf

Clinical Research Unit, Academic Medical Centre, Amsterdam, the Netherlands

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JPWR Roovers

JPWR Roovers

Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands

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First published: 24 August 2012
Citations: 27
MME Lakeman, Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, the Netherlands. Email [email protected]

Trial registration: Nederlands Trial Register: Trial number NTR 1795. Acronym: Ligasure (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1795).

Abstract

Please cite this paper as: Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012;119:1473–1482.

Objective To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy.

Design Randomised controlled trial.

Setting Eight teaching hospitals in the Netherlands.

Population One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse.

Methods Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery.

Main outcome measures Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs.

Results The evening after surgery, women in the vessel-sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0–10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 €, P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used.

Conclusion Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.