Adhesive Versus Spatial Anatomical Distortion Determines Energy Device Performance in Complex Total Laparoscopic
Cenk Mustafa Güven1, Şebnem Özgür2, Dilek Uysal3
1Department of Obstetrics and Gynecology, Izmir University of Economics Faculty of Medicine, Izmir, Turkey.
The Journal of Obstetrics and Gynaecology Research
|July 27, 2026
Summary
In complex total laparoscopic hysterectomy (TLH), the choice of energy device impacts performance based on anatomical distortion. LigaSure (LG) is faster for spatial distortion (enlargement), while conventional bipolar electrosurgery (CBP) is better for adhesive disease.
Area of Science:
- Minimally Invasive Gynecologic Surgery
- Surgical Technology
- Pelvic Surgery
Background:
- Complex total laparoscopic hysterectomy (TLH) presents unique surgical challenges.
- Energy devices play a critical role in achieving hemostasis and facilitating dissection during TLH.
- The type of anatomical distortion, whether spatial (e.g., uterine enlargement) or adhesive (e.g., from prior surgery or endometriosis), may influence device performance.
Purpose of the Study:
- To determine if the type of anatomical distortion influences the relative effectiveness of different energy devices during complex TLH.
- To compare the performance of conventional bipolar electrosurgery (CBP) and LigaSure (LG) in the context of spatial versus adhesive distortion.
Main Methods:
- Retrospective cohort study of 167 women undergoing complex TLH at a single tertiary referral center.
- Cases were categorized by intraoperative findings: spatial distortion, adhesive distortion, or combined.
- Comparison of operative time, blood loss, and hospital stay between CBP and LG groups, with subgroup analysis based on distortion type.
Main Results:
- Overall operative time, hemoglobin change, and hospital stay were similar between CBP and LG groups.
- A significant interaction was found between device type and distortion: LG was faster in spatial distortion (90 vs. 110 min), while CBP was faster in adhesive distortion (140 vs. 155 min).
- Bladder injury occurred more frequently with LG in patients with prior cesarean delivery. Conversions to laparotomy were similar between devices.
Conclusions:
- Energy device selection in complex TLH should be guided by the type of anatomical distortion.
- LigaSure (LG) demonstrates operative advantages in cases with spatial distortion (uterine enlargement).
- Conventional bipolar electrosurgery (CBP) shows superiority in cases with adhesive disease, supporting an anatomy-driven approach to device selection.
