Laparoscopic hysterectomy using various energy sources in swine: A histopathologic assessment

Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington DC, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 07/2011; 205(5):494.e1-6. DOI: 10.1016/j.ajog.2011.07.009
Source: PubMed


Analyze energy-induced damage to the swine vagina during laparoscopic hysterectomy.
Laparoscopic colpotomy was performed in swine using ultrasonic, monopolar, and bipolar energy. Specimens (n = 22) from 13 swine were stained with hematoxylin and eosin and Masson's trichrome for energy-related damage. The distal scalpel-cut margin was used as reference. Energy induced damage was assessed by gynecologic and veterinary pathologists blinded to energy source.
Injury was most apparent on Masson's trichrome, demonstrating clear injury demarcation, allowing consistent, quantitative damage measurements. Mean injury was 0 ± 0 μM (scalpel, n = 22), 782 ± 359 μM (ultrasonic, n = 7), 2016 ± 1423 μM (monopolar, n = 8), and 3011 ± 1239 μM (bipolar, n = 7). Using scalpel as the reference, all were significant (P < .001).
All energy sources demonstrated tissue damage, with ultrasonic showing the least and bipolar the greatest. Further study of tissue damage relative to cuff closure at laparoscopic hysterectomy is warranted.

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    • "Gruber et al. performed a histopathologic assessment to compare the thermal damage after the use of ultrasonic, monopolar and bipolar energy for colpotomy in swine. They concluded that ultrasonic energy causes the least and bipolar energy the greatest tissue damage [21]. In all our procedures, including those complicated by a VCD, ultrasonic energy was used for colpotomy and additional bipolar energy was used for haemostasis (Table 3). "
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    ABSTRACT: Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH.
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