Electrosurgical bipolar vessel sealing for radical abdominal hysterectomy

Objective. We analyzed the use of an electrosurgical bipolar vessel sealing system for radical abdominal hysterectomy. Methods. We compared operating time, transfusion requirements and other surgical parameters in 52 patients undergoing radical abdominal hysterectomy with systematic pelvic +/- paraaortic lymphadenectomy for stage IB1-IIB cervical cancer between January 2001 and June 2004. At 21 operations between January 2001 and March 2002, the pararnetrium, paracolpos and vaginal cuff were resected with clamps and the pedicles suture ligated; 31 operations between November 2001 and June 2004 were done with a bipolar vessel sealing system (LigaSure Vessel Sealing System, Valleylab, Boulder, CO). Four surgeons did all operations. Data were compared with the t test. Results. Patients operated with the LigaSure system received fewer packed RBC transfusions than those operated with clamps (mean, 0.61 +/- 1.1 vs. 2.14 +/- 2.6 units, respectively; P = 0.01), even when looking at patients who underwent only pelvic (without paraaortic) lymphadenectomy (mean, 0.52 +/- 1.1 vs. 1.29 +/- 1.2 units, respectively; P = 0.02). The transfusion rate in the two groups was 26% (8/31) and 67% (14/21), respectively (P < 0.05). Operating time did not differ significantly (199 +/- 33 vs. 213 +/- 45 min, respectively). There were no significant differences between the groups in number of pelvic nodes removed, febrile morbidity, postoperative stay, or days until residual urine <100 ml. One patient in the LigaSure group developed a ureterovaginal fistula that resolved with stenting. Conclusion. The LigaSure system appears useful to reduce blood loss at radical abdominal hysterectomy. (C) 2004 Elsevier Inc. All rights reserved.