Comparison of Three Techniques for Ovarian Pedicle Hemostasis During Laparoscopic‐Assisted Ovariohysterectomy

Abstract

To describe the safety, surgical time, and complications associated with 3 techniques for achieving hemostasis during laparoscopic-assisted ovariohysterectomy (LAOVH). Prospective, randomized clinical trial. Female dogs (n=30). Dogs were randomly assigned to 1 of 3 methods for achieving ovarian pedicle hemostasis during LAOVH: extracorporeal modified Roeder knot application (suture group), metal clip application using a multifire 10 mm laparoscopic clip applier (clip group), or use of a novel 5 mm bipolar vessel-sealing device (vessel-sealing group). In all dogs a 3 median portal technique was used. Controlling for the dogs' bodyweights, there was a significant association between surgical time and which method for hemostasis was used. This association was different when comparing the first 5 procedures using each method to the second 5. For a 20 kg dog, the surgical time (95% CI) for the first 5 procedures was 80 (69-91), 68 (57-79), and 33 (21-45) minutes for the suture, clip, and vessel-sealing groups, respectively. For the second 5 procedures surgical time was 71 (60-81), 50 (39-60), and 40 (29-51) minutes. Pedicle hemorrhage occurred in all dogs in the clip group, 3 dogs in the suture group, and none of the dogs in the vessel-sealing group although in all cases was considered hemodynamically inconsequential. All dogs recovered uneventfully. All methods of hemostasis were safe for pedicle sectioning. A learning curve exists for clip and suture methods. Use of a vessel-sealing device significantly shortens surgical time and provides excellent hemostasis during LAOVH.