Ascertaining the Effects of Tissue Sealers on Minor Laparoscopic Procedures between Obstetrics and Gynecology Residents: A Prospective Cohort Study

Background and Objectives: The type of instrumentation used during laparoscopic surgery might impact on the learning curve of resident surgeons. The aim of this study was to investigate differences in operator satisfaction and surgical outcomes between tissue sealers and classic bipolar instruments during gynecological laparoscopies performed by residents. Materials and Methods: A prospective cohort study conducted at two tertiary university hospitals between March 2019 and March 2021, on consecutive procedures: salpingo-oophorectomies (Group 1) and salpingectomies (Group 2), subdivided according to the utilized device: radiofrequency tissue sealers (Groups A1 and A2) or bipolar forceps (Groups B1 and B2). Results: 80 procedures were included. Concerning salpingo-oophorectomies, better visibility (8.4 +/- 0.8 vs. 7.3 +/- 0.9; p = 0.03), reduced difficulty (5.4 +/- 1.2 vs. 7.0 +/- 1.4; p = 0.02), improved overall satisfaction (9.2 +/- 0.4 vs. 7.6 +/- 1.0; p = 0.02) and reduced procedure time (7.8 +/- 3.4 vs. 12.6 +/- 3.1; p = 0.01) were reported by residents using tissue sealers. Intraoperative blood loss (12.2 +/- 4.7 mL vs. 33.2 +/- 9.7 mL; p = 0.01) and 24 h postoperative pain (4.5 +/- 1.1 vs. 5.7 +/- 1.8; p = 0.03) were lower in group A1 than B1. For salpingectomies, a significant reduction in duration was found in A2 compared to B2 (7.2 +/- 3.4 min vs. 13.8 +/- 2.2 min; p = 0.02). Tissue sealers enhanced visibility (8.1 +/- 1.1 vs. 6.7 +/- 1.4; p = 0.01), difficulty (6.5 +/- 1.1 vs. 7.5 +/- 0.9; p = 0.04) and improved satisfaction (9.3 +/- 0.5 vs. 7.5 +/- 0.6; p = 0.01). Moreover, hemoglobin loss and postoperative pain were reduced in A2 relative to B2 [(8.1 +/- 4.2 % vs. 4.5 +/- 1.1%; p = 0.02) and (5.1 +/- 0.9 vs. 4.1 +/- 0.8; p = 0.03), respectively] Conclusions: The use of sealing devices by residents was related to reduced difficulty as well improved visibility and overall satisfaction, with improved surgical outcomes.

Automated summary

This study investigated the differences between tissue sealers and classic bipolar instruments in gynecological laparoscopies performed by residents. The results showed that residents using tissue sealers reported better visibility, reduced difficulty, improved overall satisfaction, and reduced procedure time. Tissue sealers also reduced intraoperative blood loss and postoperative pain in salpingo-oophorectomies.