VAGINAL HYSTERECTOMY USING ELECTROFUSION:

A STUDY OF 96 CASES

Jean DUBUISSONJean DUBUISSON Daniel RAUDRANTDaniel RAUDRANTFrançois GOLFIERFrançois GOLFIERMona MASSOUDMona MASSOUD

Hôtel Dieu – Lyon,Hôtel Dieu – Lyon, France FranceCentre Hospitalier Lyon-Sud,Centre Hospitalier Lyon-Sud, France France

OBJECTIVE

• To compare ligature by electrofusion vs. sutures in the practice of vaginal hysterectomy

METHOD

• Retrospective study on 96 patients completed over a period of 47 months (from april 2002 to februar 2006)

• Inclusion :

Simple vaginal hysterectomy without concomitant procedure and with the same technique Under general anaesthesia With or without salpingo-oophorectomy ELECTROFUSION or SUTURE

RESULTS

• 54 procedures in the suture-free group

24 with LigaSure TM 30 with BiClamp TM

• 42 procedures in the suture control group

RESULTATSELECTROFUSION

N = 54

SUTURE (control group)

N = 42

p

AGE (years)

50,0 ± 9,4 48,4 ± 7,4 NSNS

PARITY

2,0 ± 1,2 2,0 ± 1,2 NSNS

Previous caesarean section

0,07 ± 0,43 0,12 ± 0,40 NSNS

weight of the postoperative specimen (grams)

194,2 ± 116,5 167,5 ± 84,5 NS

TYPE OF SURGERY

ELECTROFUSION

N = 54

SUTURE

N = 42 p

Vaginal hysterectomies with salpingo-oophorectomy

19 (55,9%) 15 (44,1%)

NSNSVaginal hysterectomies without salpingo-oophorectomy

35 (56,5%) 27 (43,5%)

RESULTS

MAIN INDICATIONSELECTROFUSION

N = 54 (%)

SUTURE

N = 42 (%)

p

FIBROID

29 (52,7%) 26 (47,3%)

NSNS

ADENOMYOSIS

8 (47,1%) 9 (52,9%)

Carcinologic pathology,

cervical dysplasia 10 (71,4%) 4 (28,6%)

OTHERS 7 (70,0%) 3 (30,0%)

RESULTS

ELECTROFUSION N = 54

SUTURE

N = 42

p

VAS MAX / 24h

1,9 ± 2,0 3,5 ± 2,3<0,001

Timing of morphine administration (hours)

22,4 ± 13,4 29,4 ± 18,8<0,05

Cumulative doses (mg) 22,4 ± 31,0 45,4 ± 51,3

<0,05

Associated analgesics

0,94 ± 0,79 1,60 ± 0,96 <0,001

RESULTSPost-operative pain evaluation

RESULTSComparison of operating time and hospitalization

post-op

ELECTROFUSION N = 54

SUTURE

N = 42

p

OPERATING TIME

(min) 51,3 ± 22,6 67,6 ± 20,1<0,001

HOSPITALIZATION POST-OP

(days)4,2 ± 1,3 5,0 ± 1,0

<0,001

ELECTROFUSION

• 1 vaginal hemorrhage not requiring surgical intervention

• 1 bladder injury • 1 conversion to laparotomy

(deep infiltrating endometriosis)

SUTURE

• 1 vaginal hemorrhage requiring surgical intervention

• 1 bladder injury• 1 haematoma of the vault

RESULTSComplications

CONCLUSION

ELECTROFUSION reduces significantly the operating time, postoperative pain and the

duration of hospitalization without increasing the rate of perioperative complications. The

use of electrofusion during vaginal surgery appears to be safe and simple. Moreover, it requires only minimal training in hands of

experienced surgeons.