Total Vaginal Hysterectomy Using a Vessel Sealer Device Vs. Conventional Suture Ligation Technique: A Retrospective Cohort Analysis

Abstract

<h3>Study Objective</h3> The aim of this study is to evaluate the duration of surgery, blood loss, and complications when performing a total vaginal hysterectomy (TVH) using a blood vessel sealer (BVS) device compared to standard technique. <h3>Design</h3> retrospective cohort analysis. <h3>Setting</h3> Tertiary care center serving a rural population. <h3>Patients or Participants</h3> 146 women undergoing TVH at the West Virginia University Hospitals system. The indications for the vaginal hysterectomy were recorded as either abnormal uterine bleeding (AUB), pelvic organ prolapse (POP), or other. Patient characteristics were recorded. The primary endpoint was the comparison of surgical times between the BVS and standard technique groups. Secondary endpoints were the amount of blood loss and complications after surgery between both groups. Complications were defined by blood loss >500 ml, conversion to laparotomy/laparoscopy, blood transfusion, urinary or bowel injury, readmission within 30 days, postoperative fever, and vaginal wall or labial burning. <h3>Interventions</h3> Use of a vessel sealer vs conventional technique. <h3>Measurements and Main Results</h3> Out of 142 surgeries, 102 patients had hysterectomies using standard technique and 40 used the BVS device. The two most common hysterectomy indications were AUB (32 with the vessel sealer and 45 with conventional technique) and POP repair (8 with the vessel sealer and 57 with conventional technique). Although the BVS group had faster surgical times than the standard technique group, the difference was not statistically significant (99.4 vs 112.1 minutes; p=0.0777). There was a significant difference in surgical blood loss in the vessel sealer group compared to the group of traditional surgery (240.5 vs 169.1 mL; p = 0.0343). There were no significant differences in complications following a TVH with a vessel sealer compared to the standard technique (OR=0.61; 95% CI 0.24 - 1.52). <h3>Conclusion</h3> The use of the vessel sealer device was not associated with decreased surgical times or complications and instead showed an increase in surgical blood loss.