title: Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial.
abstract: OBJECTIVE
  To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Eight teaching hospitals in the Netherlands.
  
  
  METHODS
  One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse.
  
  
  METHODS
  Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery.
  
  
  METHODS
  Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs.
  
  
  RESULTS
  The evening after surgery, women in the vessel-sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0-10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 €, P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used.
  
  
  CONCLUSIONS
  Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands. m.m.lakeman@amc.uva.nl
authors.forename: M M E
authors.initials: MM
authors.lastname: Lakeman
authors.forename: S
authors.initials: S
authors.lastname: The
authors.forename: R P
authors.initials: RP
authors.lastname: Schellart
authors.forename: V
authors.initials: V
authors.lastname: Dietz
authors.forename: J F
authors.initials: JF
authors.lastname: ter Haar
authors.forename: A
authors.initials: A
authors.lastname: Thurkow
authors.forename: P C
authors.initials: PC
authors.lastname: Scholten
authors.forename: M G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: J P W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003250:Constriction; D004598:Electrosurgery / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods*; D057194:Intention to Treat Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D059952:Pelvic Floor Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000191:economics; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control