Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Efficacy and Safety of Electrothermal Bipolar Vessel Sealer

vs ENSEAL in Total Laparoscopic Hysterectomy for Large

Uterus: A Comparative Study in Mysuru, South India

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Prathap Talwar , Swathi Hassan Kumarachar , Lakshmi Velayudam , Tohreen Fathima 4
AbstrAct
Context: Hysterectomy is the most commonly performed gynecological procedure around the world. Hemostasis is of major concern in an
enlarged uterus as chances of hemorrhage are more. New laparoscopic vessel sealing devices have been developed for laparoscopic tissue
dissection and vessel sealing. In this study, an ALAN vessel sealer, an indigenous electrothermal bipolar vessel sealing device, is compared with
ENSEAL device with respect to safety, efficacy, and perioperative outcomes in laparoscopic hysterectomy for a large uterus.
Aims and objectives: This study aimed to determine the efficacy and safety of electrothermal bipolar vessel sealer (ALAN vessel sealer) vs
ENSEAL in total laparoscopic hysterectomy (TLH) for a large uterus.
Materials and methods: This prospective randomized case–control study included 100 women who underwent TLH for a large fibroid uterus.
Of them, 50 women underwent TLH using ALAN vessel sealer, and the remaining 50 using ENSEAL. Efficacy, safety, and perioperative outcomes
of both the groups were compared.
Statistical analysis: Statistical analysis was done using SPSS version 16.0 software. For evaluating continuous variables and discrete variables,
independent T-tests, and Chi-square tests, respectively, were used.
Results: Duration of surgery in ALAN vessel sealer group was 56.90 ± 12.45 minutes and in ENSEAL group was 57.25 ± 13.54 minutes (p = 0.9)
and mean blood loss in group A and group B was 111.40 ± 22.32 and 107.84 ± 20.33 mL, respectively ( p = 0.4), both of the data were not
statistically significant. No significant differences were noticed in the demographic characteristics, intraoperative, and postoperative complications
between the two groups.
Conclusions: The ALAN vessel sealer is safe and as efficient as ENSEAL in decreasing blood loss and operative time when laparoscopic hysterectomy
is performed for an enlarged uterus. It is cost-effective and a promising instrument for TLH in developing countries.
Keywords: Electrothermal vessel sealers, ENSEAL, Laparoscopic hysterectomy, Large uterus.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1431

IntroductIon 1 Department of Obstetrics and Gynecology, JSS Hospital, Mysuru,
The study aimed to determine the efficacy and safety of Karnataka, India
electrothermal bipolar vessel sealer (ALAN vessel sealer) vs ENSEAL 2–4 Department of Obstetrics and Gynecology, JSS Academy of Higher
in total laparoscopic hysterectomy for large uterus. Education and Research, Mysuru, Karnataka, India
Hysterectomy is the most commonly performed gynecological Corresponding Author: Kumarachar SH, Department of Obstetrics and
procedure around the world. Laparoscopic hysterectomy is a safe Gynecology, JSS Academy of Higher Education and Research, Mysuru,
and efficient alternative to abdominal hysterectomy in managing Karnataka, India, Phone: +91 9972044959, e-mail: hkswat2193@gmail.
benign gynecological conditions as it offers less blood loss, com
minimal postoperative discomfort, shorter duration of stay, faster How to cite this article: Talwar P, Kumarachar SH, Velayudam L, et al.
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convalescence, and fewer wound complications. Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL
Large uteri are always a technical challenge for laparoscopic in Total Laparoscopic Hysterectomy for Large Uterus: A Comparative
surgery. Regardless of the surgical approach used, removal of an Study in Mysuru, South India. World J Lap Surg 2021;14(1):5–9.

extremely large uterus is a challenge to surgeons. Most of the studies Source of support: Nil
set the uterine weight of more than 500 gm as a large uterus. Giant Conflict of interest: None
myomas obstruct the pelvis and make the uterus extremely difficult to
mobilize and manipulate. They also reduce the visibility of surrounding
anatomy and impair the surgeon’s ability to correctly develop spaces. to uterine vascular pedicles. In laparoscopic surgery, conventional
Various studies have demonstrated increased intraoperative bleeding mechanical hemostatic techniques like sutures or clips have
and postoperative complications when TLH is performed for a large almost completely been replaced by coagulation techniques
uterus of more than 500 gm though few studies have also concluded using monopolar coagulation, bipolar coagulation, and ultrasonic
that it is safe and feasible than laparotomy. 1,2 instruments. These new electrosurgical devices have inbuilt tissue
Hemostasis is of major concern, especially in the enlarged response generators, which provide computer-controlled feedback
uterus as chances of hemorrhage are more due to limited access that senses tissue impedance, thereby allowing a consistently

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