Laparoscopic hysterectomy: Randomized study of harmonic scalpel and electrosurgery

Citation
Z. Holub et al., Laparoscopic hysterectomy: Randomized study of harmonic scalpel and electrosurgery, J GYNECOL S, 16(1), 2000, pp. 33-39
Citations number
21
Categorie Soggetti
Reproductive Medicine
Journal title
JOURNAL OF GYNECOLOGIC SURGERY
ISSN journal
10424067 → ACNP
Volume
16
Issue
1
Year of publication
2000
Pages
33 - 39
Database
ISI
SICI code
1042-4067(200021)16:1<33:LHRSOH>2.0.ZU;2-6
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, Endosc opy Training Center at Baby Friendly Hospital, Kladno, Czech Republic. The women were randomly allocated to one of the two groups in which electrosurg ery or the harmonic scalpel was used as the primary method of hemostasis an d dissection. The following comparative criteria were studied: indication f or 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 chi-square test at p = 0.05 sig nificance level when necessary. In the electrosurgical hemostasis and lapar osonic 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 n o significant differences between the groups in any intraoperative or posto perative follow-up variables. In three patients with larger fibromyomas, th e harmonic scalpel was ineffective (successful procedure rate 91.6%). The e lectrosurgery technique was effective in all cases without exception. It is concluded that the two variants of operative technique in laparoscopic hys terectomy appear to be feasible and effective for gynecologic conditions. F urthermore, the electrosurgery was demonstrated to be superior to the harmo nic scalpel in cases of larger fibromas as well as better in terms of cost effectiveness. The advantages of the laparosonic technique include less cha rring and plume, better visualization, and less thermal injury, particularl y in respect to the important surrounding pelvic structures.