Comparative Study of Electrosurgical Bipolar Vessel Sealing Using Ligasure Versus Conventional Clamping and Suturing for Total Abdominal Hysterectomy and Bilateral Salpingoophrectomy

Abstract

A thorough understanding of the surgical anatomy of the uterus, blood and nerve supply is a fundamental step before being endulged in any surgical procedure. Hysterecromy is one of the most frequently performed gynaecologic surgical procedures. Three main types of hysterectomy are now used abdominal, vaginal and laparoscopic. Each approach has its own indications, advantages and disadvantages but keeping in mind that abdominal approach remains the fall back option when any deviation from any straight forward procedure arise. Abdominal Hysterectomy (AH) is the standard procedure for gynecological malignancy and several benign indications. The abdominal surgical approach is an accepted effective treatment, clamping and suturing technique remains the method of choice for many years, currently there appears to be widespread use of electrosurgical techniques which achieves better outcome among these methods, the knowledge of electrosurgery will allow surgeons both in open and endoscopic cases to address a more complex pathology in an efficient and minimally invasive fashion. Electrosurgical vessel sealing (EBVS) systems have been developed to seal large tissue bundles and blood vessels, up 7 mm diameter. Placing sutures on distant pedicles deep in the pelvis is a significant challenge for the majority of gynaecologists. Reliable vessel sealing with EBVS reduces haemorrhage and facilitates safety and haemostasis in situations of difficult access. The aim of the current study is to assess the effectiveness of electrosurgical bipolar vessel sealing versus the conventional clamping and suturing for securing the vascular pedicles. 150 patients were admitted from the gynaecological outpatient clinic were scheduled for total abdominal hysterectomy for certain indications which were similar in the study groups, these groups were randomizedly divided into two groups, one performed hysterectomy using electrosurgical bipolar vessel sealing and the other group used the