الفهرس 
The History of Vaginal HysterectomyOnly 14 pages are availabe for public view
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Abstract
The vaginal hysterectomy (VH) is associated with significant benefits in terms of reduced hospital stay, better post-operative quality of life, a shorter period of convalescence, higher satisfaction rate and can be considered a minimally invasive procedure. VH requires careful and accurate hemostasis; there is a quest for faster and efficient hemostatic techniques that can safely replace conventional suture ligation.
Electrosurgical vessel sealing (EBVS) systems have been developed to seal large tissue bundles and blood vessels, up to 7 mm diameter for some models.
Placing sutures on distant pedicles deep in the pelvis is a significant challenge for the majority of gynecologists. Reliable vessel sealing with EBVS reduces hemorrhage and facilitates safety and hemostasis in situations of difficult access.
Objective:
The aim of the current study was to assess the safety and efficacy of using electrosurgical bipolar vessel sealing(EBVS)system for securing the pedicles in comparison with the conventional method during vaginal hysterectomy and to examine whether investing this new technology of bipolar vessel sealing can make the transition from abdominal to vaginal hysterectomy easier.
Methods:
68 patients scheduled for vaginal hysterectomy for benign pathology were randomized to electrosurgical bipolar vessel sealing (Ligasure) and sutures as the hemostasis technique.
Procedure time was assessed in the form of total operative time and pedicle securing time (time from securing the first pedicle to closure of the vaginal cuff) with satisfactory hemostasis. Blood loss was estimated intraoperatively and postoperatively by measuring hemoglobin level 24 hours later. Delay discharge form hospital and occurrence of intra and postoperative complications were also reported. Additional use of hemostatic sutures in ligasure was also recorded.
Results:
There were no significant differences between women of the two groups regarding age, parity, weight, BMI, menstrual status and comorbidities and regarding indications for VH.
The mean estimated intraoperative blood loss was lowest in women of group I [Ligasure Group] than in women of group II [Conventional Group]. The difference regarding the mean intraoperative blood loss between groups I and II was significant.
The difference regarding the mean postoperative hemoglobin concentration wasnot significant. The mean postoperative hemoglobin DROP was highest in women of group II (Conventional Group) than in women of group I (Ligasure Group). The differences regarding the mean hemoglobin DROP between groups I and II was significant.
The mean total operative time was lowest in women of group I [Ligasure Group] than in women of group II [Conventional Group] and The difference regarding the mean total operative time between groups I and II was highly significant.
The mean pedicle securing time was lowest in women of group I [Ligasure Group] than in women of group II [Conventional Group). The difference regarding the mean pedicle securing time between groups I and II was highly significant.
Regarding intra, postoperative complications and postoperative hospital stay, the difference between the two study groups was not significant. The pain status was lowest in group I (ligasure) than in women of group II (conventional group) and the difference between both groups was significant. There was no cases needed suture for pedicle securing in group I [Ligasure Group].
Electrosurgical bipolar vessel sealing (Ligasure) is an effective alternative to sutures in vaginal hysterectomy, resulting in significantly reduced operative time and blood loss without increasing the rate of occurrence of complications.