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Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus
unique design and construction of the plasma bisector, the tissues Table 1: Baseline and demographic characteristics
close to the dissection area also get a small concentration of current, Group-A Group-B
which helps provide better hemostasis and cut the tissues without (N = 50) (N = 50) p-value
causing any bleeding. Vessel sealing can be done with the same Age, years (mean ± SD) 43.68 ± 5.35 45.06 ± 5.79 0.21
instrument by varying the pressure and applying a bipolar sealing
current. But this sealing needs some expertise from the surgeon as BMI* (mean ± SD) 25.37 ± 2.47 25.52 ± 2.25 0.21
this instrument is essentially designed for dissection. Parity, n
As per the manufacturer’s instructions, standard settings were Nulli 3 3 0.7
maintained. Instruments were used for both vessel sealing and Primi 5 3
Multi
42
44
tissue transection.
All the subjects were administered required perioperative History of previous surgeries, n 43 45 0.73
None
antibiotics and the standard approach for TLH was adopted. The Yes 7 5
patients were put in a lithotomy position. Foley’s catheterization
was done and then a uterine manipulator was inserted. Using one Group-A, ALAN vessel sealer; Group-B, ENSEAL; *BMI: body mass index
10-mm and three 5-mm trocars and cannulas, abdominal access
was obtained. The 10-mm port was introduced supraumbilical or
5 cm above the upper border of the uterus, whichever was higher. Table 2: Weight of the uterus in different groups
After creating pneumoperitoneum, both the pelvis and abdomen Group-A Group-B p-value
were inspected for any abnormalities interfering with the surgical Weight of uterus, g 451.60 ± 150.39 447.80 ± 154.87 0.9
approach. The site, size, and the number of myomas were assessed (mean ± SD)
at the start of the procedure. Manipulation of a large uterus may be
very difficult so a myoma screw was inserted through one of the
5-mm ports for uterus manipulation, wherever necessary. Table 3: Intraoperative findings
Sequential bipolar sealing and transection of the round
ligaments, bipolar sealing, and transection of the infundibulopelvic Group-A Group-B p-value
ligament in patients with risk-reducing salpingo-oophorectomy Blood loss, mL 111.40 ± 22.32 107.84 ± 20.33 0.4
(RRSO) or utero-ovarian ligament and fallopian tube in patients (mean ± SD)
without salpingo-oophorectomy, opening of the ureterovesical fold Operative time, 56.90 ± 12.45 57.25 ± 13.54 0.9
and mobilizing the bladder downwards, sealing and transection of min (mean ± SD)
bilateral uterine vessels were done using Alan vessel sealer in group Complications
A and ENSEAL in group B. Colpotomy was done using Alan vessel Bowel injury 0 0 NA
sealer in group A and monopolar hook in group B. Removal of the Bladder injury 0 0
uterus was done by vaginal morcellation. Vaginal cuff closure was
done by vaginal route. At the end of vault closure, the laparoscope
was reintroduced to ensure adequate hemostasis. Table 4: Postoperative findings
Group-A Group-B p-value
results Complications (n)
Secondary hemorrhage 2 1 0.68
The patients with fibroid uterus of 12–28-week sizes were randomly Leukorrhea/vault granulation 4 3 0.78
allocated to undergo laparoscopic hysterectomy with either Alan Vault dehiscence 0 0 NA
vessel sealer or ENSEAL. All the procedures were done successfully Bladder complications 1 1 NA
by laparoscopy and no patient was converted to laparotomy in our Bowel complications 0 0 NA
study. The baseline patient characteristics including age, parity,
BMI, and history of previous surgeries were found similar in both
the groups and showed no statistical significance as depicted in Intraoperative complications involving bladder or bowel were also
Table 1. noted in both groups (Table 3).
The weight of the uterus was measured after the specimen During the postoperative period, all the subjects were followed
retrieval following the surgery. The mean weight of the uterus in up with general, abdominal and vault examinations at 2-, 4-,
group A was 451.60 ± 150.39, and 447.80 + 154.87 g in group B, and 6-week to look for complications. Two cases of secondary
which was comparable between groups (p = 0.9) (Table 2). hemorrhage in the ALAN vessel sealer group and one case in
Operative time was recorded from the transection of the ENSEAL group were noted. Leukorrhea or vault granulation was
first pedicle until the completion of colpotomy. It was noted seen totally in seven cases, with 4 cases in group A, and 3 cases
that the duration of surgery in the ALAN vessel sealer group in group B. Bladder complications were one case in each group
was 56.90 ± 12.45 minutes and in the ENSEAL group was and were followed by an examination that reported them as
57.25 ± 13.54 minutes. Hence, there was an insignificant difference vesicovaginal fistula. All the complications were similar in both the
in the total time taken for surgery in both groups. groups and were statistically insignificant as are depicted in Table 4.
Blood loss in the intraoperative period was assessed by
measuring the amount of blood in the suction apparatus
minus the irrigation fluid. In group A, the mean blood loss was dIscussIon
111.40 ± 22.32 mL and in group B it was 107.84 ± 20.33 mL. There was Laparoscopic hysterectomy has been the subject of controversy
no statistically significant blood loss between the groups (p = 0.4). when it comes to the large uterus. Many studies have concluded

World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021) 7