Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy

OBJECTIVE: To compare blood loss and procedure time of vaginal hysterectomy using an electrosurgical bipolar vessel sealer versus using sutures. METHODS: Sixty patients scheduled for vaginal hysterectomy in a single surgical practice were randomized to either electrosurgical bipolar vessel sealer or sutures as the hemostasis technique. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the anesthesia service. Statistical methodology included the Student t and Wilcoxon rank-sum tests, and all comparisons were two tailed, with P < .05 considered significant. RESULTS: Use of an electrosurgical bipolar vessel sealer resulted in shorter procedure times: The mean procedure time in the electrosurgical bipolar vessel sealer arm was 39.1 minutes (range 22-93) versus 53.6 minutes (range 37-160) for the suture arm (P = .003). Mean estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer: 68.9 mL (range 20-200) versus 126.7 mL (range 25-600) for the suture arm (P = .005). Complication rate and length of stay did not differ by hemostasis technique. Seventy-eight percent of all cases were outpatient. CONCLUSION. Electrosurgical bipolar vessel sealer is an effective alternative to sutures in vaginal hysterectomy, resulting in significantly reduced operative time and blood loss. (C) 2003 by The American College of Obstetricians and Gynecologists.