Use of a Vessel Sealer for Hysterectomy at Time of Prolapse Repair: A Randomized Clinical Trial.

Importance: Electrosurgical vessel sealing devices for vaginal hysterectomy have demonstrated reduced postoperative pain. This modality, however, has not been evaluated in patients undergoing vaginal hysterectomy with pelvic reconstruction.

Objective: The aim of the study was to describe postoperative pain levels utilizing the LigaSure vessel sealing device for vaginal hysterectomy in patients undergoing major reconstructive surgery.

Study design: In this single-blinded, randomized controlled trial, participants were randomized to vaginal hysterectomy utilizing the LigaSure vessel sealing device versus standard clamping and suturing techniques. Following hysterectomy, all participants underwent major vaginal reconstruction, including apical suspension via high uterosacral ligament fixation. The primary outcome was postoperative pain on a 100-mm visual analog scale 3-6 hours after surgery. Secondary outcomes included hysterectomy operative time, blood loss, pain scores and narcotic use on days 1, 3, 5, and 2 weeks after surgery.

Results: A total of 95 participants were randomized: 48 (50.5%) in the intervention arm and 47 (49.5%) in the control arm. Between 3 and 6 hours postoperatively, there was no difference in overall pain scores (49 vs 50.5). Groups also had similar hysterectomy operative times (40.5 minutes vs 38 minutes) and blood loss (100 mL vs 100 mL). Pain scores and narcotic use on postoperative days 1, 3, 5, and 2 weeks were not different.

Conclusions: While vessel sealing devices may reduce pain after vaginal hysterectomy alone, these benefits were not detected following concomitant major pelvic reconstruction. Similar operative times and blood loss between groups may be due to the expertise of the surgical subspecialist and not the device itself.