Electrosurgical Devices Used During Laparoscopic Hysterectomy

Abstract

Background: Hysterectomy is one of the most common surgical procedures performed in the United States and most are now being performed in a minimally invasive approach. Electrosurgery and vessel sealing devices are needed in order to provide hemostasis and vascular coaptation; however, there is no guiding evidence and limited recommendations for the use of the currently available devices for laparoscopic hysterectomy. The purpose of this study is to provide a systematic review of electrosurgical devices used in benign hysterectomy and perform a meta-analysis to find the overall effect of various outcomes.

Database: A systematic review was performed by searching the literature using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Review, Science Citation Index Expanded, Emerging Sources Citation Index, Scopus, Epistemonikos, and SciELO databases from each database's inception date until May 2023.

Conclusion: Advanced bipolar vessel sealing devices demonstrate reduced blood loss and operative times when compared to conventional electrosurgery, however more high-quality evidence and cost analysis is needed to strengthen the clinical significance of these findings.

Keywords: Advanced bipolar vessel sealing device; Electrosurgery; Gynecology; Laparoscopy; Minimally invasive gynecologic surgery; Ultrasonic device.

Figure 1.

PRISMA flow diagram of study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.

Figure 2.

Forest plots for estimated blood loss. (A) Forest plot for estimated blood loss when LigaSure is compared to Enseal. N, number of patients; SD, standard deviation; CI, confidence interval. (B) Forest plot for estimated blood loss when conventional electrosurgery is compared to LigaSure. N, number of patients; SD, standard deviation; CI, confidence interval. (C) Forest plot for estimated blood loss when conventional electrosurgery is compared to plasma kinetic system. N, number of patients; SD, standard deviation; CI, confidence interval.

Figure 3.

Risk of bias for estimated blood loss. (A) Risk of bias for estimated blood loss in randomized controlled trials (risk of bias tool for randomized trials). (B) Risk of bias for estimated blood loss in nonrandomized studies (risk of bias in nonrandomized studies – of interventions).

Figure 4.

Forest plots for operative time. (A) Forest plot for operative time when LigaSure is compared to Enseal. N, number of patients; SD, standard deviation; CI, confidence interval. (B) Forest plot for operative time when conventional electrosurgery is compared to Enseal. N, number of patients; SD, standard deviation; CI, confidence interval. (C) Forest plot for operative time when conventional electrosurgery is compared to LigaSure. N, number of patients; SD, standard deviation; CI, confidence interval. (D) Forest plot for operative time when conventional electrosurgery is compared to plasma kinetic system. N, number of patients; SD, standard deviation; CI, confidence interval.

Figure 5.

Risk of bias for operative time. (A) Risk of bias for operative time in randomized controlled trials (risk of bias tool for randomized trials). (B) Risk of bias for operative time in nonrandomized studies (risk of bias in nonrandomized studies – of interventions).

Figure 6.

Forest plots for uterine weight. (A) Forest plot for uterine weight when LigaSure is compared to Enseal. N, number of patients; SD, standard deviation; CI, confidence interval. (B) Forest plot for uterine weight when conventional electrosurgery is compared to Enseal. N, number of patients; SD, standard deviation; CI, confidence interval. (C) Forest plot for uterine weight when conventional electrosurgery is compared to LigaSure. N, number of patients; SD, standard deviation; CI, confidence interval. (D) Forest plot for uterine weight when conventional electrosurgery is compared to plasma kinetic system. N, number of patients; SD, standard deviation; CI, confidence interval.

Figure 7.

Risk of bias for uterine weight. (A) Risk of bias for uterine weight in randomized controlled trials (risk of bias tool for randomized trials). (B) Risk of bias for uterine weight in nonrandomized studies (risk of bias in nonrandomized studies – of interventions).