Institutional members access full text with Ovid®

ACOG MEMBER SUBSCRIPTION ACCESS

If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Energy-Based Vessel Sealing in Vaginal Hysterectomy: A Systematic Review and Meta-Analysis

Kroft, Jamie MD, FRCSC; Selk, Amanda MD, FRCSC

doi: 10.1097/AOG.0b013e3182324306
Reviews

OBJECTIVE: To estimate the effect of energy-based vessel sealing compared with suturing in women undergoing vaginal hysterectomy with respect to surgical outcomes.

DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. We also screened references from relevant articles and searched trial registries and other sources of unpublished literature.

METHODS OF STUDY SELECTION: Randomized controlled trials comparing the use of energy-based vessel sealing devices with traditional suturing of vascular pedicles for vaginal hysterectomy, in women of any age, were included.

TABULATION, INTEGRATION, AND RESULTS: Two authors completed independent data extraction and bias assessment of included articles. We used the Grading of Recommendations Assessment, Development and Evaluation methodology to assess bias across studies at the outcome level. Data were pooled based on the random effects model. Seven studies met inclusion criteria (n=662). Energy-based vessel sealing devices decreased operative time by a mean of 17.2 minutes (seven studies, 662 patients; 95% confidence interval [CI] 7.5–27.0) blood loss by a mean of 47.7 mL (five studies, 437 patients; 95% CI 15.5–79.9), drop in hemoglobin by 0.3 g/dL (two studies, 291 patients; 95% CI 0.1–0.6), and postoperative hospital stay by 0.25 days (five studies, 554 patients; 95% CI 0.13–0.37). There was no increase in the rate of complications for energy-based vessel sealing compared with traditional suturing.

CONCLUSION: This review suggests that energy-based vessel sealing devices may decrease operating time, blood loss, and hospital stay. There was no difference in complication rate and no studies investigated mortality or quality of life.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, http://www.crd.york.ac.uk/PROSPERO, CRD42011001124.

The use of energy-based vessel sealing devices for vaginal hysterectomy compared with suturing may decrease operative time, blood loss, and hospital stay.

From Sunnybrook Health Sciences Centre, Department of Obstetrics and Gynecology, and Women's College Hospital, Department of Gynecology, University of Toronto, Toronto, Canada.

An Appendix detailing the search strategy for this study is available online at http://links.lww.com/AOG/A261.

The authors thank Louise-Helene Gagnon for translating the French language publication included in this review as well as Elie Akl for instruction in the formulation and preparation of systematic reviews and editorial support.

Corresponding author: Jamie Kroft, MD, FRCSC, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Room C703, Toronto, Ontario, Canada, M4N 3M5; e-mail: Jamie.kroft@utoronto.ca.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.