title: Vaginal hysterectomy and multimodal anaesthesia with bipolar vessel sailing (Biclamp(®) forceps) versus conventional suture technique: quality results' analysis.
abstract: OBJECTIVE
  The medical and economic benefits of the transvaginal approach over the abdominal and laparoscopic methods are demonstrated in many studies. Vaginal hysterectomy with bipolar vessel sailing (BiClamp(®)) represents an example of mininvasive surgery and could be a valid and cost-benefit alternative in the surgical treatment of benign gynaecologic disease. BiClamp(®) may be carried out according to Clavè's technique with a good result in postoperative pain.
  
  
  METHODS
  Prospective randomized study (Canadian Task Force classification I). We compared the vaginal hysterectomy with salpingo-oophorectomies with BiClamp(®) and multimodal anaesthesia (group A 30 patients) with vaginal hysterectomy with salpingo-oophorectomies and spinal anaesthesia (group B 30 patients).
  
  
  RESULTS
  The median operating time was 33.5 min for group A and 54.5 min for group B (p < 0.0001). The median blood loss was 59.25 ml in group A and 81.75 ml in group B. The median hospital stay was 1.6 ± 0.58 days for group A and 2.55 ± 0.66 days for group B. Postoperative pain was statistically different between groups in the immediate postoperatory times, at 2 and at 6 h from the surgery and at 10 p.m. (p < 0.0001). Analyses of cost-effectiveness have stated advantages in terms of costs and indirect-direct benefits but also in earlier resumption of working.
  
  
  CONCLUSIONS
  BiClamp(®) technique with multimodal anaesthesia has advantages from surgical, anaesthesiology and economic point of view. It is a minimally invasive surgery characterised by lower morbidity, quicker surgery times and reduced costs when compared to classical vaginal hysterectomy. BiClamp(®) technique represents a new border in vaginal surgery.
authors: Advanced Gynecological Oncology Centre, Department of Obstetrics and Gynecology, University "A. Avogadro", Via Solaroli 17, 28100 Novara, Italy.
authors: Livio
authors: L
authors: Leo
authors: Francesca
authors: F
authors: Riboni
authors: Carlo
authors: C
authors: Gambaro
authors: Daniela
authors: D
authors: Surico
authors: Nicola
authors: N
authors: Surico
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000191:economics; D000775:Anesthesia, Spinal / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000295:instrumentation*; D008875:Middle Aged; D010052:Ovariectomy; D011446:Prospective Studies; D058994:Salpingectomy; D013536:Suture Techniques