A Comparative Study of Use of Different Electrosurgical Techniques for Opening The Vaginal Cuff In Total Laparoscopic Hysterectomy: Monopolar Cutting, Coagulating And Harmonic Scalpel.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 2
Abstract
Introduction: With the evolution of laparoscopic gynaecological surgeries the use of electrosurgery for haemostasis and cutting has also become widespread. In cases of total laparoscopic hysterectomy vault opening is one crucial step from the safety point of view.while the use of different electrosurgical techniques for this step vary from surgeon to surgeon, we compared the safety and efficacy of monopolar electric current (ME) , bipolar electric current(BE) and Harmonic Scalpel(HS) in dissection of vault. The differences in vaginal cuff complication rate was evaluated between coagulation and cutting modes of monopolar current too.We also studied the post operative histological status of surrounding tissue and healing process after the use of different electrosurgical techniques. Methods: we used the above methods for opening of vaginal cuff in TLH surgeries conducted at AMRI hospital, Bhubaneswar from january 2013 to december 2016. The total number of such surgeries conducted was 184. The ease and amount of hemostasis achieved , the preciseness of cut margin attained following vault opening , degree of surrounding tissue destruction ( histological evidence) and post operative healing process ( in terms of post operative hospital stay, vaginal discharge and secondary haemorrhage) were noted. Results: The postoperative complications were significantly lower in cutting mode group compared to he monopolar coagulating mode because of decreased thermal spread, but it was least in the harmonic scalpel group. BE and HS achieved almost complete hemostasis with excellent post operative healing. The amount of surrounding tissue destruction was remarkably low in cutting mode than the coagulating mode. While with ME the vault margin attained was very precise but with poor haemostasis , for which BE was again used. Greater thermal injury with more inflammatory response was seen with ME,while the post operative period was uneventful. BE causes slightly greater inflammatory response than LS. Conclusion: Vaginal cuff complications like vaginal discharge and secondary haemorrhage occur more frequently when vagina is entered by using electrosurgery with coagulation technique.Cutting technique is clearly a safe method for vaginal cuff opening, but gain requires the use of bipolar energy. BE is a safe and efficient method of hemostasis and ME could cause clinical and histological complications. BE causes slightly greater inflammatory response than HS though not much difference in the incidence of post operatve incidence of discharge and secondary haemorrhage was seen between them.
Authors and Affiliations
Dr. G S S Mohapatra, Dr. Bharat Bhusan
Keywords
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- EP ID EP592025
- DOI 10.9790/0853-1602049294.
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