Laparoscopic hysterectomy using laparosonic coagulating shears: experience of 15 cases.
In conventional laparoscopic hysterectomy, adequate hemostasis is provided by bipolar coagulation, staple, and suture. The Laparosonic Coagulating Shears (LCS) have been proven to give both hemostasis and cutting. The objective of this study was to evaluate the efficacy of the LCS for laparoscopic hysterectomy. Fifteen patients indicated for hysterectomy were enrolled for laparoscopic hysterectomy using LCS. Each procedure was performed under general endotracheal anesthesia. The LCS were operated at power level 1 though 5. All pedicles, blood vessels, and tissues were coagulated and cut by LCS. The cardinal ligaments were cut and ligated transvaginally. The uterus was removed through the vagina. The operative finding, uterine volume and weight, operative time, CO2 volume, blood loss and hospital stay were recorded. Among the 15 cases, the indications were myoma uteri (7 cases), adenomyosis (6 cases) and adenomyosis with endometriomas (2 cases). The mean volume of the uterus was 226.8 cm3 (range 77-399 cm3) and mean weight was 188.8 g (range 85-320 g). Mean operative time was 171.6 min (range 114-210 min) and CO2 loss was 313.8 liters (range 120-650 liters). Blood loss was 366.7 ml (range 100-1,500 ml). LCS can be used for coagulation and cutting simultaneously. Minimal charring and smoke was observed during operation. In general, the hospital stay was 3 days (range 2-4 days), except for one case of recto-sigmoid injury and 2 cases of ureteric injury when the hospital stay was 7, 10, and 12 days, respectively. The injuries occurred in cases with anatomic distortion, profuse bleeding, and dense adhesion. LCS can be used as an alternative instrument for coagulation and dissection. According to our experience, it produces less charring and smoke compared to electrocoagulation. However, a high rate of complications were still encountered.
Srisombut
C
C
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Weerakiet
S
S
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004715:Endometriosis / Q000473:pathology / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D009929:Organ Size; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery