Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial
Article first published online: 9 APR 2013
© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 6, pages 776–777, May 2013
How to Cite
Soreefan, A. and Beebeejaun (2013), Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 776–777. doi: 10.1111/1471-0528.12162
- Issue published online: 9 APR 2013
- Article first published online: 9 APR 2013
- Manuscript Accepted: 6 DEC 2012
We read with much interest the paper by Lakeman et al., published in the November 2012 issue of BJOG. In so doing, they are helping to promote vaginal hysterectomy (VH) for the non-descent uterus. This procedure hitherto remains the domain of a minority of gynaecological surgeons, despite being the recommended route.[2, 3] We cannot but stress the importance of this gynaecological operation.
Moreover, we would have been keen to learn about the uterine pathologies involved in their study as well as the overall rate of VH. We have changed from laparoscopically assisted VH to straight VH, and have performed over 800 such procedures for uterine fibroids ranging between 200 and 700 g in weight. We have attained a VH rate of 50% or more for hysterectomies involving non-descent uteri.
We would like to point out that securing the uterosacrals and cardinal ligaments, as well as myoreduction (viz. morcellation, wedge resection, intramyometrial coring, etc.), steps that are necessary to complete the surgical intervention, are the more cumbersome and time-consuming aspects of the procedure.
Suitable clamps and correct needle placement are primordial for conducting VH safely and avoiding complications. In proficiently trained hands ligaturing the large pedicles (>7 mm) encountered should be as quick as, if not quicker than, bipolar coagulation. There is also a question mark regarding bipolar coagulation of atheromatous vessels. We are of the opinion that trainees would benefit most by practising to conventionally secure pedicles, which requires a high level of skill and dexterity in many a tight situation encountered during VH.
More often than not VH also allows for the early discharge of patients within 48–72 hours, thus further curtailing expenses.
In the present cost-conscious climate, we find it hard to justify the additional costs despite the advantages mentioned.
- 2American College of Obstetrician Gynaecologist Committee Opinion. Choosing the Route of Hysterectomy for benign disease. Obstet Gynecol 2009;114:1156–8.
- 3Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009, Issue 3. Art. No. CD003677., , , , , , et al.