title: LigaSure vessel sealing system in vaginal hysterectomy: safety, efficacy and limitations.
abstract: OBJECTIVE
  The aim of this study is to compare vaginal hysterectomy performed with standard technique versus the one performed with LigaSure.
  
  
  METHODS
  Observational-longitudinal-cohort study on 42 women candidates to vaginal hysterectomy because of benign uterine pathology. Outcome variables, methods of analysis, inclusion and exclusion criteria were determined prospectively. Eligible patients were subdivided in Group-A (LigaSure-21 patients), or in Group-B (classical-21 patients). Group-A was divided into Subgroup-A1 (10 patients) and Subgroup-A2 (11 patients), depending on the point where the stump of the uterosacral-ligament was transfixed: Subgroup-A1 at cervical portion, Subgroup-A2 at intermediate portion. For all patients were reported: pre-post surgery haemoglobin and hematocrit, number of sutures, duration of intervention and blood loss, NRS-score on first/third post-operative days. All patients underwent gynaecological examination 30 and 180 days after surgery.
  
  
  RESULTS
  General characteristics did not show significant differences between the two groups. Statistically significant differences emerged from the comparison between Group-A versus Group-B in terms of: intraoperative bleeding, post-operative value of haemoglobin, Δ-Hb, number of sutures, surgical time, pain at first and third post-operative day. The 180 days follow-up demonstrated four cases of vaginal vault prolapse, only in the Subgroup-A1 related to thermal damage of the uterosacral ligament.
  
  
  CONCLUSIONS
  LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy with significant improvement in patients outcome. Following vaginal vault prolapse, we determined the optimal fixation-site to perform the colposuspension in the intermediate portion of the uterosacral-ligament, especially if the cervical portion received a thermal damage, as occurs during the LigaSure use.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy, ginecologia_padova@libero.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Giorgia
authors.initials: G
authors.lastname: Burul
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Laura
authors.initials: L
authors.lastname: Lamparelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001810:Blood Volume; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D008022:Ligaments / Q000293:injuries; D008137:Longitudinal Studies; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D013537:Sutures; D014591:Uterine Diseases / Q000097:blood / Q000601:surgery*; D014596:Uterine Prolapse / Q000209:etiology
chemical_list: D006454:Hemoglobins