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Laparoscopic hysterectomy using various energy sources in swine: a histopathologic assessment
Daniel D Gruber1, William B Warner, Eric D Lombardini
1Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington DC, USA.
Objective:
Analyze energy-induced damage to the swine vagina during laparoscopic hysterectomy.
Study Design:
Laparoscopic colpotomy was performed in swine using ultrasonic, monopolar, and bipolar energy. Specimens (n = 22) from 13 swine were stained with hematoxylin and eosin and Masson's trichrome for energy-related damage. The distal scalpel-cut margin was used as reference. Energy induced damage was assessed by gynecologic and veterinary pathologists blinded to energy source.
Results:
Injury was most apparent on Masson's trichrome, demonstrating clear injury demarcation, allowing consistent, quantitative damage measurements. Mean injury was 0 ± 0 μM (scalpel, n = 22), 782 ± 359 μM (ultrasonic, n = 7), 2016 ± 1423 μM (monopolar, n = 8), and 3011 ± 1239 μM (bipolar, n = 7). Using scalpel as the reference, all were significant (P < .001).
Conclusion:
All energy sources demonstrated tissue damage, with ultrasonic showing the least and bipolar the greatest. Further study of tissue damage relative to cuff closure at laparoscopic hysterectomy is warranted.
