Laparoscopic radical hysterectomy using pulsed bipolar system: comparison with conventional bipolar electrosurgery.
OBJECTIVE
To compare the efficacy, results and complications of using the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopic radical hysterectomy and pelvic lymphadenectomy in the management of early invasive cervical carcinoma.


METHODS
This was a retrospective case-control study. We recruited consecutively 38 patients with cervical cancer for laparoscopic radical hysterectomy with pulsed bipolar system. For comparison, we recruited consecutively the latest 38 patients with cervical cancer for laparoscopic radical hysterectomy with conventional bipolar electrosurgery in the same period. From Jan. 2001 to Dec. 2005, total 76 patients with cervical cancer for laparoscopic radical hysterectomy were recruited for statistical analysis.


RESULTS
No significant difference was found between the two groups in terms of age, body weight, staging, and hospital stay. There were statistically significant difference in blood loss and operative time. The blood loss was more in conventional bipolar electrosurgery group (mean 564 ml, median 500 ml, range 50-2400 ml) compared with pulsed bipolar system group (mean 397 ml, median 350 ml, range 100-1200 ml) (p<0.03). But there was no statistically significant difference in blood transfusion between the two groups (p=0.454). The operation time for the conventional bipolar electrosurgery group (mean 229 min, median 232 min, range 121-352 min) was longer than that for the pulsed bipolar system group (mean 172 min, median 177 min, range 65-267 min) (p<0.001). None of the laparoscopic procedure was required to be converted to laparotomy. There was no significant difference in the intra-operative complication, but there was statistically less postoperative complication in the pulsed bipolar system group (p<0.01). There was no significant difference in recurrence rate in both groups.


CONCLUSIONS
Our findings indicate that pulsed bipolar system is more effective in laparoscopic radical hysterectomy when compared with conventional bipolar electrosurgery. Pulsed bipolar system has advantage over conventional bipolar electrosurgery in less blood loss, shorter operative time, less postoperative complication and may offer an alternative option for patients undergoing laparoscopic radical hysterectomy.
Lee
Chyi-Long
CL
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, and Chang Gung University, College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
Huang
Kuan-Gen
KG
Wang
Chin-Jung
CJ
Lee
Pei-Shan
PS
Hwang
Lih-Lian
LL
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D004598:Electrosurgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*