Energy-based vessel sealing in vaginal hysterectomy: a systematic review and meta-analysis

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

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 We also screened references from relevant articles and searched trial registries and other sources of unpublished literature.

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.

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.

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.