The Value of Knife Add-on to Vessel Sealing Devices: A Retrospective Comparison of Covidien Ligasure Impact and ERBE Biclamp 200 in Non-descent Vaginal Hysterectomy

Abstract

: Background: non-descent vaginal hysterectomy (NDVH)is the differentiating procedure of gynecologic surgeons, introducing a new technique is crucial. Aim: To contrast perioperative consequences of employing Covidien LigaSure Impact™ with built-in add-on knife (Curved Large Jaw Open Sealer / Divider) and ERBE BiClamp®200C (Curved Sealer) standalone forceps with use of separate scissors for executing NDVH. Patients and methods: A retrospective analysis included 164 NDVH executed between January 2015 and April 2023 in Benha University Hospital. The LigaSure Impact™ group included 86 NDVH. The BiClamp® group included 78 NDVH. Results: Both groups showed no significant dissimilarity regarding their age, BMI, parity, preoperative mean hemoglobin levels, associated comorbidities, numbers of prior Cesarean section (CS), the indications for hysterectomy, the preoperative HBA1c or the preoperative hospital administration(P>0.05). Also, there was no difference between both groups in operative time, blood loss, removed uterine weight, intra-operative complications, need for blood transfusion, rates of incidental cystotomy, need for additional general anesthesia intraoperatively, shorter postoperative hospital stay, wound complications, less consumption of analgesic and lower amount as well as the need for postoperative venous thromboembolic prophylaxis (VTE), earlier ambulation, earlier return to daily activity, earlier resumption of coital activity, need to reoperate for wound-related complication (P>0.05). Conclusion: NDVH could be safely and efficiently achieved either Covidien LigaSure Impact™ or by ERBE BiClamp®200C. The gynecologist should follow the recommendations of gynecologic societies at least for feasible mobile non-scared uteri with uterine size up to 12 weeks needed to be extirpated to be accomplished vaginally.