Comparison of ultrasonic shears and traditional suture ligature for vaginal hysterectomy: Randomized controlled trial

摘要

Study Objective: To compare operating time, intraoperative blood loss, postoperative analgesia, and length of hospital stay using ultrasonic shears vs traditional suture ligature in vaginal hysterectomy. Design: Randomized controlled trial (Canadian Task Force classification I). Setting: Gynecology units within a single health network, university hospital. Patients: Forty women requiring vaginal hysterectomy because of benign disease. Interventions: Vaginal hysterectomy performed using either ultrasonically activated shears (USS) or traditional suture ligatures. Measurements and Main Results: Twenty-one patients were randomized to the USS arm, and 19 patients to the traditional suture ligature arm. Patient characteristics were comparable. Mean (SD) hysterectomy time and was similar in both the USS and traditional arms, 28.66 (4.0) minutes vs 32.37 (3.18) minutes (p=.47), as was total operating time, 97.38 (8.9) minutes vs 91.63 (7.69) minutes (p=.63). Operative blood loss was significantly decreased in the USS group: 62.63 (12.46) mL vs 136.05 (21.54) mL (p=.006). There was, however, no significant change in hemoglobin concentration between the 2 groups: 19.53 (1.79) g/L vs -16.72 (2.5) g/L. There was no significant difference in mean oxycodone use: 9.29 (2.66) mg vs 8.06(3.19) mg (p=.77). Length of hospital stay was similar in both groups: 58.98 (3.27) hours vs 60.05 (6.48) hours (p=.88). There was no significant difference in overall complication rates between the groups. Conclusion: Although the Harmonic scalpel system, compared with the traditional suture ligation method, seems to be a safe alternative for securing the pedicles in vaginal hysterectomy, it offers no benefit insofar as operative time, reduction in clinically significant blood loss, and analgesic requirements.