Use of the LigaSure™ vessel sealer in total abdominal hysterectomy (2005)

The rapid, safe, and complete sealing of vessels remains an important part of a successful total abdominal hysterectomy (TAH). Although today the morbidity associated with radical hysterectomy is low, hemorrhage and prolonged operative time are still common [1]. The objective of this brief communication was to evaluate the safety and efficacy of the LigaSure™ Vessel Sealer System (LVSS) (Valleylab, Boulder, CO) when used for TAH. Until recently, the LVSS had not been used for TAH. To our knowledge, this is the first preliminary report that evaluates the efficacy and the advantages of the LVSS when used for TAH. Over the last 3 years, of the 36 women who underwent TAHs in which the LVSS was used at our institution, 21 had ovarian cancer, 8 had leiomyomatosis, 6 had endometrial carcinoma, and colon cancer had metastasized to the uterus in 1 woman. Demographic and histopathologic characteristics, operative time, blood loss, and complications were assessed. Total abdominal hysterectomy was successfully completed in all patients. Dissection of the uterus was easy and proceeded expeditiously in each case. No intraoperative complications were recorded and additional sutures were never necessary. Mean operative time, intraoperative blood loss, and length of postoperative hospital stay are summarized in Table 1. The LVSS is a device recently introduced in general and abdominal surgery. Applying a precise amount of bipolar energy and pressure to the tissue being dissected permits vessel sealing by changing the nature of the vessel wall. With this device, collagen and elastin within the vessel wall fuse into a single structure that obliterates the lumen, thereby reducing the risk of hemorrhage [2]. A feedback-control mechanism, with an automatic “off” switch when the impedance reaches a critical level, ensures that tissues are not charred by overcoagulation. The seal integrity in 3- to 7-mm vessels approximates the burst strength of ligatures and clips. Moreover, the device resists dislodgment and, because it requires a minimal need for dissection before application, it provides greater ease of dissection; and of course, no foreign material can be left behind. In recent studies comparing the effects of this device with those of ultrasonic coagulation, bipolar coagulation, and surgical clips and sutures demonstrated that the LVSS creates seals that are stronger than the seals obtained with other energy-based ligation methods, and similar in strength to those obtained with mechanical ligation techniques [2]-[4]. The LVSS decreased operative time because of two factors. First, the double clamping, cutting, and suturing of the uterosacral and cardinal ligaments and vascular structures were replaced by the application of the LVSS. Second, the use of the LVSS facilitated the dissection of the distal ureter through the parametrium. The LVSS appeared to be a fast and reliable instrument for the dissection and coagulation of tissue on the lateral and anterior aspects of the vena cava and aorta, and around the iliac vessels and the obturator fossa. The operative field was practically bloodless, allowing for easier and faster dissection. A small amount of smoke did not obscure the view. In conclusion, these preliminary results suggest that the LVSS provides an effective, fast, and safe alternative to the other methods used for TAH, as it facilitates dissection and decreases operating time and blood loss.