Vaginal hysterectomy electrosurgery or sutures?

Full Text

Objective: to compare procedure time, blood loss, postoperative period of vaginal hysterectomy using sutures versus using an electrosurgical bipolar plasma kinetic generator GYRUS.

Materials and methods. During 2005, we perform 64 vaginal hysterectomies, in patients without vaginal vault prolapse at the age from 36 to 64 years with a following pathology: adenomyosis, fibroid, necrosis of fibroid after embolisation, uterine carcinoma (1A). The sizes of a uterus appear to be 6 -14 weeks of gestation. Patients were dividing in two groups: either electrosurgical bipolar vessel sealer (8, Gyrus PlasmaKinetic SuperPulse Generator) or sutures (56, Vicryl) as the hemostasis technique. In the last group sutures were use for the vaginal repair. Technique of the operation is made by the circumcision of the vagina, anterior and posterior colpotomy. Cardinal, uterosacral ligaments, bundles of uterine vessels, round, utero-ovarian ligaments, uterine tubes are cut and ligate in the standard fashion. In the Gyrus bipolar coagulation use the special Wertheim-like clump. Above-mentioned structures sealed and scissored. Then uterus is morcelated. The vagina is restored by vicryl sutures, in both groups performing high McCall’s culdoplasty. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff. Blood loss estimated by a method of weigh-in, postoperative period is clinically.

Results. Patients from the first group required administration of narcotic analgesics up to 48 hours. In the second group administration NSAID is quite enough. Duration of the hospitalization for the 3-5 days in the first group and 2-3 days the second. Patients were observed is outpatient department within 2 months. Procedure time in the first group was 53.6 min, for the second group - 28 minutes. Mean blood loss was 60 ml in the bipolar sealer arm versus 130 ml for suture arm. 1 (1,8%) patient of the suture arm experienced right leg pain resolved within 14 days without treatment. 3 (5,3%) patients of the first group was poor healing of vaginal wound that has required local outpatient treatment. There are no complications in the electrosurgical bipolar vessel sealer group.

Conclusions. Vaginal hysterectomy can be performed as standard technique in challenging patients with morbid obesity, significantly enlarged uteri, narrow vaginal canals, without vaginal vault prolapse, a uteri carcinoma (1A). Electrosurgical bipolar plasma kinetics coagulation reduce time of operation, blood loss, postoperative period is practically painless. Generator Gyrus cheaper then LigaSure System almost twice, which makes it more preferably for today.

About the authors

A. I. Slobodianiouk

Central City Clinical Hospital

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Zhukovsky

I. V. Mazohin

Central City Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Zhukovsky

В. А. Slobodianiouk

Central City Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Zhukovsky

Е. М. Kim

Central City Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Zhukovsky

М. О. Suchalko

Central City Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Zhukovsky

А. Т. Timerbekova

Central City Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Zhukovsky

References

Supplementary files