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Energy-based vessel sealing may prove beneficial in vaginal hysterectomy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Energy-based vessel sealing appears to decrease operating time, blood loss, and hospital stay in women undergoing vaginal hysterectomy, researchers say.

“Energy-based vessel sealing has the potential to improve operative capability and surgical outcomes,” Dr. Jamie Kroft from University of Toronto, Toronto, Canada told Reuters Health by email. “However, at the present time, there is not enough high quality research that has been performed to justify their high cost. Future high quality studies are needed.”

Energy-based vessel sealing devices (which use bipolar energy, ultrasonic energy, or nanotechnology) allow for rapid sequential tissue and vessel sealing, coagulation, and transection of the pedicle in one handheld tool, but whether their use is associated with increased benefits or complications remains unclear.

Dr. Kroft and colleagues undertook a systematic review to estimate the effect of energy-based vessel sealing compared with suturing on surgical outcomes in women undergoing vaginal hysterectomy. Their findings appear in the November Obstetrics and Gynecology.

Seven studies, all randomized controlled trials, involving a total of 662 participants were included in the meta-analysis.

Energy-based vessel sealing devices decreased operative time relative to suturing by 17.2 minutes. The LigaSure device offered the greatest decrease in operative time (22.5 minutes less), whereas the BiClamp device showed no significant decrease in operative time.

Use of energy-based vessel sealing devices was associated with a significant 47.7 mL decrease in estimated blood loss and a significant 0.3 g/dL decrease in the drop in hemoglobin postoperatively compared with preoperatively.

Hospital stay was decreased by 0.25 day in the energy-based vessel sealing device group compared to the suturing group.

The pooled effect estimate could not rule out a clinically important increase or decrease in the risk of major complications, but postoperative pain was less when LigaSure was used than when BiClamp was used.

It’s worth noting that the quality of evidence for all outcomes was either low or very low, and there was a suggestion of publication bias.

“I don’t believe there is strong evidence at the present time based on the systematic review and meta-analysis that energy-based vessel sealing should be recommended because of the low quality of studies included as well as the lack of clinical significance of the outcomes,” Dr. Kroft concluded. “Often, new technology becomes popularized because of industry pressure and advertising, although there is no evidence currently to justify the increased cost of using energy-based vessel sealing devices for use in vaginal hysterectomy.”

“I believe it is imperative that we continue to strive to increase the proportion of hysterectomy that is performed in a minimally invasive fashion,” Dr. Kroft added. “If this proves to be a safe option as compared to the traditional technique, then future research is needed to determine if the ease of performing the procedure is minimized by using this technology. This may increase both the proportion and complexity of cases that can be performed vaginally. If that is the case, the increase in cost of the device may be negligible compared to the cost savings and patient benefits that would be incurred by decreasing the proportion of abdominal hysterectomy.”

Reference:Energy-Based Vessel Sealing in Vaginal Hysterectomy: A Systematic Review and Meta-Analysis

Obstet Gynecol 2011;118:1127-1136.