EBVS in Vaginal Hysterectomy Benefits Patients, Surgeons

Compared with conventional clamping and suturing, the use of electrosurgical bipolar vessel sealing (EBVS) during vaginal hysterectomy was associated with shorter operating time and less postoperative pain, according to results of a new study conducted in The Netherlands.¹

Vaginal hysterectomy is considered the safest and most cost-effective way to remove the uterus, but only 22% of all hysterectomies performed in the United States are vaginal.^2,3 One reason that some surgeons may be reluctant to perform vaginal hysterectomies is that the conventional method of clamping and suturing is more technically challenging, requiring a high level of skill and dexterity.⁴ EBVS is a surgical technique that allows for complete hemostasis in tissue bundles and blood vessels up to 7 millimeters in diameter, offering an alternative to traditional suturing and stapling. EBVS also requires less space because fewer surgical instruments need to be used simultaneously, making a vaginal hysterectomy feasible even in patients with a narrow vagina or immobile uterus.

To determine the effects of EBVS (using LigaSure) on postoperative pain, recovery, cost, and urinary symptoms, researchers randomized 100 women undergoing a vaginal hysterectomy for benign conditions, excluding pelvic organ prolapse, to either vessel sealing or conventional suturing. Significantly less pain was reported by women in the vessel-sealing group on the evening after surgery. However, after that first night, the pain scores were similar between groups. The only other outcome that reached statistical significance in this study was operating time, which was shorter for the vessel-sealing group (60 minutes vs 71 minutes for the suturing group). Blood loss and duration of hospital stay did not differ between study groups, nor were symptoms related to defecation or micturation affected by the surgical technique used. The average cost of the procedures was similar.

“Surgery seems to be faster using vessel sealing,” the study authors’ conclude.1 “However, the shorter operation duration does not completely compensate for the costs of the LigaSure clamp. Patients may benefit from the use of a vessel-sealing technique because the postoperative pain during the first night after surgery is less.”

In terms of procedure time and pain reduction, these findings are similar to other studies comparing EBVS with suturing.^4,5 Unlike in this study, EBVS has also been shown to significantly reduce blood loss.⁴

Pertinent Point
- Use of electrosurgical bipolar vessel sealing as a surgical technique for vaginal hysterectomy can significantly reduce the duration of surgery as well as postoperative pain on the first day of surgery.

References:

1. Lakeman M, The S, Schellart R, et al. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG. 2012; doi:10.1111/j.1471-0528.2012.03484.x.
2. Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database System Rev. 2009;3:CD003677.
3. Wu JM, Wechter ME, Geller EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110:1091-1095.
4. Levy B, Emery L. Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy. Obstet Gynecol. 2003;102:147-151.
5. Cronje HS, de Coning EC. Electrosurgical bipolar vessel sealing during vaginal hysterectomy. Int J Gynaecol Obstet. 2005;91:243-245.