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.