Laparoscopic Hysterectomy: Randomized Study of Harmonic Scalpel and Electrosurgery

Abstract

The aim of this study was to compare peroperative parameters of two groups of women with different operative techniques in laparoscopic hysterectomy, in a randomized trial. The setting was the Department of Gynecology, Endoscopy Training Center at Baby Friendly Hospital, Kladno, Czech Republic. The women were randomly allocated to one of the two groups in which electrosurgery or the harmonic scalpel was used as the primary method of hemostasis and dissection. The following comparative criteria were studied: indication for surgery, history of previous surgical treatment, duration of procedure, hospital stay, costs incurred, blood loss, and incidence of complications. Statistical analysis was performed with the chisquare test at p = 0.05 significance level when necessary. In the electrosurgical hemostasis and laparosonic groups, the mean times required to secure and cut, on one side, the infundibulopelvic and round ligaments were 9.9 and 10.1 min, respectively, whereas those required to finish the whole procedure were 90.6 and 82.9 min, without any statistically significant difference (p = 0.24). There were no significant differences between the groups in any intraoperative or postoperative follow-up variables. In three patients with larger fibromyomas, the harmonic scalpel was ineffective (successful procedure rate 91.6%). The electrosurgery technique was effective in all cases without exception. It is concluded that the two variants of operative technique in laparoscopic hysterectomy appear to be feasible and effective for gynecologic conditions. Furthermore, the electrosurgery was demonstrated to be superior to the harmonic scalpel in cases of larger fibromas as well as better in terms of cost effectiveness. The advantages of the laparosonic technique include less charring and plume, better visualization, and less thermal injury, particularly in respect to the important surrounding pelvic structures. (J GYNECOL SURG 16:33, 2000)