Henri Clavé1, Arnaud Clavé2. 1. Service de Chirurgie Gynécologique, Clinique Saint-George, Nice, France. 2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Service de Chirurgie Orthopédique, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France. Electronic address: arnaud.clave@orange.fr.
Abstract
STUDY OBJECTIVE: To determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DESIGN: A retrospective cohort (Canadian Task Force classification III). SETTING: High-volume gynecologic surgeon practice, private hospital. PATIENTS: One thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. INTERVENTIONS: Vaginal hysterectomy performed using an EBVS device. MEASUREMENTS AND MAIN RESULTS: One thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31-88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42-105) and 25.8 ± 4.2 kg/m2 (range, 19.1-38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6-19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01-19.2) were associated with a higher risk of urinary complications. CONCLUSION: The use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.
STUDY OBJECTIVE: To determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DESIGN: A retrospective cohort (Canadian Task Force classification III). SETTING: High-volume gynecologic surgeon practice, private hospital. PATIENTS: One thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. INTERVENTIONS: Vaginal hysterectomy performed using an EBVS device. MEASUREMENTS AND MAIN RESULTS: One thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31-88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42-105) and 25.8 ± 4.2 kg/m2 (range, 19.1-38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6-19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01-19.2) were associated with a higher risk of urinary complications. CONCLUSION: The use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.