Abstract

VAGINAL HYSTERECTOMY WITH THERMO-FUSION HEMOSTATIS

A.A. Rabarijaona*, M. Rhemimet, O. Sardaoui, Najia Zeraidi, Amina Lakhdar, Aziz Baydada

ABSTRACT

Vaginal approach should be considered as gold standard in hysterectomy. The technique of Electrosurgical bipolar vessel sealing (EBVS) has emerged as a safe and effective alternative to the technique of ligature in conventional surgery. Aim of the study: The objective of this study is therefore to review literature on EBVS in practice of vaginal: its technique, the advantages in particular on the complications, the blood loss, the operative time, the postoperative pain, the hospital stay, the cost, number of sutures, demonstrating its safety and effectiveness. Materials and methods: We carried out a literature review. The articles were searched by the following keywords: Vaginal hysterectomy, EBVS, Thermofusion, Electrosurgery, Bicoagulation forceps, Ligasure, Innovative technique, Blood loss, Pain score, Safety, Local anesthesia. Our Database were Science direct and Pubmed. We analysis in total 35 articles. Our inclusion criteria was studies who elaborate vaginal hysterectomy using thermofusion, studies who compared it to the other techniques (suture ligation). We excluded studies about vaginal hysterectomy with thermofusion but using the V note technique. EBVS is a computer-controlled bipolar diathermy system. It is important to modify the surgical technique when using a vaginal thermofusion device. Some authors have studied this new approach on vaginal hysterectomy. Most of the results showed an operating time significantly shorter, a decreasing in operative blood loss, a less need for additional analgesics, a shortening patient’s hospital stay, while no increase in the rate of complications and a reduction of vaginal hysterectomy cost compared with traditional suturing. Main limitations of those studies are:  Their small size sample.  Majority of them have not describe the population undergoing hysterectomies.  Most of them did not specify the expertise of the surgeon or the proportion of trainees included. Conclusion: The EBVS is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. However, Large-scale, prospective randomized studies are needed to validate those preliminary result.

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