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Ventajas de la histerectomía abdominal con electrocoagulación bipolar vs histerectomía con suturas. Hospital José Carrasco Arteaga, Cuenca 2010

Abstract:

Objective: To compare the bipolar plasmakinetic vessel sealing versus standard technique with sutures when performing total abdominal hysterectomy, for to reduce blood loss, procedure time, and postoperative pain and hospital length of stay. Material and methods: Clinic controlled trial involving 120 women who underwent total abdominal hysterectomy. Sixty procedures were performed using bipolar plasmakinetics vessel sealing and the remaining 60 with the standard suture technique. In both groups the outcomes were improvement in terms of blood loss, procedure time, postoperative pain, and hospital length of stay. Results: Mean operational time was shorter with bipolar vessel sealing duration of 93,5 ± 13,9 minutes, versus 140,6 ± 25,3 minutes with standard technique, [RR 0,36 (IC 95% 0,20 – 0,63)]. The time reduction was of 47,12 min (IC95% 38,7 – 55,5) with bipolar vessel sealing group. The estimated blood loss for bipolar group was of 152,4 ± 46,1 mL, as compared to the sutures group with 356,7 ± 102,9 ml, [RR 0,10 (IC 95% 0,04 – 0,24)]. The blood loss reduction with bipolar vessel sealing group was of 204,3 ml (IC95% 174,5 – 234,08). There was a significant difference in postoperative several pain, then of 12 hours, with bipolar vessel sealing 8 (13.3%) as compared to the standard technique 46 (76.6%), (p <0.002). The several postoperative pain decrees in 71% with bipolar vessel sealing. Hours in hospital for the bipolar vessel sealing group was 49,7 ± 6,1 hours, versus 71,4 ± 18,7 hours, [RR 0,24 (IC 95% 0,14 – 0,42)]. The incidence of blood transfusions for the bipolar vessel sealing group was 5% (3/60) patients, as compared to the standard group with 25% (15/60) patients. Conclusions: Women who underwent the procedure with bipolar plasmakinetics vessel sealing showed a significant reduction in operative time, blood loss, and hospital length of stay, and the intensive pain. Don’t increase the postoperative complications. Key words: abdominal hysterectomy, bipolar energy, plasmakinetics, sutures.