Oct 25, 2011

Good Hemostasis With LigaSure in Laparoscopic Hysterectomy

Operating time and blood loss during laparoscopic hysterectomy are similar whether hemostasis is achieved with LigaSure or conventional bipolar instruments, Dutch researchers say.

LigaSure (Valleylab, Boulder, Colorado) desiccates vascular tissues using a feedback-programmed amount of bipolar diathermy, effectively closing vessels up to 7 mm with a seal that can withstand three times the normal systolic pressure, according to the researchers.

At one of the three study centers, surgeons favored the LigaSure device because of its coagulating ability, lower amount of carbonization, efficacy, and maneuverability. Surgeons at the other two centers favored the conventional bipolar diathermy device on almost all parameters.

Since there were no significant differences in objective perioperative outcomes, the choice between LigaSure and conventional bipolar instruments might come down to the surgeon’s preference — although in The Netherlands at least, the LigaSure device costs about 100 euros (US$139) more than the conventional Seitzinger and Cutting forceps, according to lead author Dr. P. F. Janssen from VU University Medical Center, Amsterdam and colleagues.

For their study, the investigators randomly assigned 140 women undergoing laparoscopic hysterectomy to have homeostasis maintained with LigaSure or standard instruments. They tested the 5-mm vessel-sealing LigaSure instrument.

The final analysis included 131 women, according to a report online September 6th in BJOG: An International Journal of Obstetrics and Gynaecology.

Mean operating time, blood loss, and hospital stay did not differ significantly between LigaSure and the conventional bipolar instruments in the total cohort or in subgroups of women who had total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy.

In the laparoscopic supracervical hysterectomy subgroup, operating time favored the conventional bipolar instruments, whereas hospital stay favored the LigaSure group.

The time required to dissect the adnexal ligaments was nearly two minutes shorter with LigaSure than with conventional instruments (2:37 vs. 4:33; P=0.02).

Two women in the LigaSure group and three in the standard bipolar group had perioperative bleeding in excess of 1000 mL. Other complications included one case of postoperative bleeding and one bladder injury in the LigaSure group, and one bowel injury, one ileus, and two cases of urinary retention in the conventional bipolar group.

“We were not able to confirm the favorable results with respect to shorter operating time and reduced blood loss with LigaSure as reported in previous published studies,” the researchers note. “However, most of these laparoscopic studies involved bowel surgery and compared LigaSure with ultrasonic devices.”

“The study was designed without any influence of manufacturers” and with no outside funding, the authors said.

SOURCE: http://bit.ly/vfQZP0

BJOG 2011.

— Reuters Health Information

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