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Comparing Thermal Damage Using Monopolar Hook Versus Harmonic Scalpel in Total Laparoscopic Hysterectomy; A Double-Blind Randomized Controlled Trial

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Abstract

Objective

The use of energy during minimally invasive surgery is associated with thermal damage that can affect the process of wound healing.

Methods

This was a randomized clinical trial including 78 women who underwent total laparoscopic hysterectomy. Patients were randomized based on the device used for colpotomy, monopolar hook versus harmonic scalpel. The thickness of the cauterized margins in the cervicovaginal tissues of the hysterectomy specimens was measured by the pathologist.

Results

The primary outcome was the amount of lateral thermal damage based on histologic assessment. Secondary endpoints included postoperative pain scores and postoperative complications. Baseline characteristics were comparable between the two groups. The amount of thermal injury in the monopolar group was significantly greater in only one region, the right lateral order of the cuff (3.85 ± 1.01 mm vs. 3.08 ± 0.95 mm (p = 0.001)). With regard to secondary outcome measures, there was no significant difference between the two groups.

Conclusion

The use of the harmonic device was associated with significantly less tissue damage during colpotomy in the right lateral cuff region. This is especially important in overweight and obese women in whom the distance between the cervix and the ureter is shorter.

Trial Registration

https://en.irct.ir/trial/33902?revision=61236. IRCT20180130038567N2.

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Data Availability

Data will be available by request.

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Acknowledgements

We are grateful to the personnel of the Endometriosis Research Center for helping us with the collection and documentation of data. We also thank the staff of the operating room of the Rasoul-e-Akram Hospital for their cooperation in performing this project. We also appreciate the help of Catherine Breed, employed by Becton Dickinson, in helping to condense the manuscript. No compensation was provided to those acknowledged.

Funding

This study has been financially supported by the Iran University of Medical Sciences, which was not involved with study design, data collection, analysis, interpretation of data, writing of the report, and/or decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran

    Mansoureh Gorginzadeh MD, Abolfazl Mehdizadehkashi MD, Shahla Chaichian MD, Kobra Tahermanesh MD, Samaneh Rokhgireh MD & Elaheh Afshari MD

  2. Department of Pathology, Iran University of Medical Sciences, Tehran, Iran

    Pegah Babaheidarian MD

  3. Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran

    Banafsheh Nikfar M.Sc

  4. Camran Nezhat Institute, Palo Alto, CA, USA

    Atena Asiaii MD, MPH

  5. Department of Obstetrics and Gynecology, Weil Cornell Medical College of Cornell University, New York, NY, USA

    Farr Nezhat MD, FACOG, FACS

  6. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, NYU-Winthrop University Hospital, State University of New York at Stony Brook College of Medicine, New York, NY, USA

    Farr Nezhat MD, FACOG, FACS

Authors
  1. Mansoureh Gorginzadeh MD
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Corresponding author

Correspondence to Shahla Chaichian MD.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

The ethics committee of the Iran University of Medical Sciences and the IRCT INSTITUTE obtained ethical approval and IRCT code.

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Written and informed consent obtained from the participants.

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Mansoureh Gorginzadeh is a Gynecologist, Obstetrician, Laparoscopic Surgeon; Abolfazl Mehdizadehkashi is a Professor, Gynecologist, Obstetrician, Laparoscopic Surgeon; Shahla Chaichian is Professor, Gynecologist, Obstetrician, Laparoscopic Surgeon; Kobra Tahermanesh is a Associated professor, Gynecologist, Obstetrician, Laparoscopic Surgeon; Samaneh Rokhgireh is a Assistant professor, Gynecologist, Obstetrician, Laparoscopic Surgeon; Pegah Babaheidarian is a Associate Professor, Pathologist; Elaheh Afshari is Gynecologist, Obstetrician, Laparoscopic Surgeon; Banafsheh Nikfar is a Ph.D. Student; Atena Asiaii is a Gynecologist, Obstetrician, Laparoscopic Surgeon; Farr Nezhat is a Professor, Gynecologic Oncologists, Laparoscopic Surgeon

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Gorginzadeh, M., Mehdizadehkashi, A., Chaichian, S. et al. Comparing Thermal Damage Using Monopolar Hook Versus Harmonic Scalpel in Total Laparoscopic Hysterectomy; A Double-Blind Randomized Controlled Trial. J Obstet Gynecol India (2024). https://doi.org/10.1007/s13224-023-01938-6

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