To Evaluate The Clinical Value Of Electrosurgical Bipolar Vessel Sealing (Ligasure) In The Use Of Transvaginal Hysterectomy

BackgroundSince hysterectomy was first performed as a vaginal procedure by Langenbeck in 1813, transvaginal hysterectomy (TVH) has taken place for nearly two hundred years. The only indication in the past for vaginal surgery was uterovaginal prolapse, but now, it has been used in some patients who need hysterectomy for benign lesions without reproductive prolapse. Comparing to abdominal hysterectomy and laparoscopical hysterectomy , most studies proved the advantages of TVH. TVH obviates the risk and recovery from an abdominal incision, and is associated with less disruption of bowel function, short procedure time, less blood loss, less pain, less risk for visceral injury and bleeding, shorter recuperation, shorter hospitalized time, and faster return to preoperative activity, most mineral-invasive procedure. Especially foe the patient with severe abdominal obesity, TVH avoids the problem of narrow surgical pelvic cavity and bad healing of the incision. It is suspected that TVH should be the most common procedure instead of abdominal hysterectomy for benign uterine conditions. Despite the widely recognized advantages of TVH, because of the high request for the patient's pelvic anatomy and the surgeon's experience of vaginal surgery, TVH can't be used widely in clinics. Recently, as the development of vaginal instruments and electrosurgical technology, some new ones make the TVH more easier to carry out . widen the indications of TVH.The Electrosurgical Bipolar Vessel Sealing(Ligasure) as a new technology of electrosurgical hemostatic mean, has been authorized by the FDA to seal vessels and vascular bundles up to 7mm in diameter in the clinical use. This new technique uses an alternate form of electrosurgery and the pressure of hemostatic forceps, to denature collagen and elastin in vessel walls and subsequently these reform into an nearly hyaline hemostatic seal. Its use in TVH can facilitates the surgical procedure with rarely suturing. In order to evaluate the clinical value of Ligasure, We analyzed sixty patients who received TVH in a single surgical procedure with different hemostatic techniques, thirty cases were with ligasure technique, and the others were with traditional suture technique.ObjectiveThroughout the analysis of the clinical documents of patients who received TVH by Ligasure or by traditional suturing, to evaluate the clinical value of Ligasure ( Electrosurgical Bipolar Vessel Sealing ) in the use of transvaginal hysterectomy(TVH).Methods1. Retrospectively, we analyzed sixty patients who received TVH in a single surgical procedure with different hemostatic techniques. Thirty cases were with ligasure technique, the others were with traditional suture technique.2. Compare the patients' general condition of the two groups, including age, BMI(body mass index) , gravidity, parity, uterine mass, and abdominal operation history, to discuss the two groups' pelvic condition.3. Compare the procedure time, the estimated blood loss, the rate of neighborly organs' injury, the rate of changing into abdominal hysterectomy, the time of bowel function recovery, the highest temperature degree after the surgery and the time of the temperature recovery of the two groups, to explore the priority of Ligasure in the use oh TVH.4. Compare the procedure time, the estimated blood loss of the patients with and without abdominal operation history in the ligasure group.5. Statistical analysis: SPSS statistical package program 13.0 were used for all analysis. Associations between means were tested by t test,X~2 test for the rates. P<0.05 were deemed significant.Results1. Between the statistics of patients' general condition, the patients' BMI (23.13±2.08/21.3±2.13, t=3.36, P=0.001) and uterine mass (7.5±2.56/5.27±1.8 weeks, t=4.350, P=0.000) in the ligasure group were significantly larger than the suture group.2. Between the statistics of effects and outcomes, The total procedure time(54.7±18.77/66.73±17.46,min,t=2.571, P=0.013), the estimated blood loss(59.67±31.92/77.0±22.84,ml, t=2.794, P=0.007) , the time of bowel function recovery (21.84±6.93/28.67±9.8, h, t=3.113, P=0.003) , the highest temperature degree after the surgery (37.42±0.44/37.84±0.11,℃, t=3.123, P=0.003) and the time of the temperature recovery (19.2±15.86/29.87±12.47, h,t=2.896, P=0.005) in the Ligasure group were significantly prior to the suture group. There was no injury of the neighborly organs in all the patients. One patient of the Ligasure group was changed into abdominal hysterectomy.3. In the ligasure group, patients without abdominal operation history were insignificantly prior to the ones with abdominal operation history in the statistics of the procedure time and the estimated blood loss.Conclusions1. As a new surgical hemostatic technique, Ligasure can safely seal vessels and vascular bundles up to 7mm in diameter in the clinical use.2. When used in TVH, Ligasure can improve the effects and outcomes of the surgery.3. Ligasure can expand the indications of TVH, especially for the patient with poor pelvic conditions, such as severe abdominal obesity, larger uterus, and abdominal operation history, is an effective alternative to sutures.