Laparoscopic hysterectomy using various energy sources in swine: a histopathologic assessment


      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.


      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).


      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.

      Key words

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      Linked Article

      • Electrosurgery research
        American Journal of Obstetrics & GynecologyVol. 206Issue 6
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          I read with interest the article by Gruber et al1 that is designed to address concerns about the zone of thermal injury associated with various energy sources used to transect the vagina at the time of total hysterectomy. On one hand, the authors have demonstrated that in their hands, with instruments and electrosurgical unit (ESU) settings presumably similar to what they use in humans, there is a progression of injury that is least with an ultrasonic scalpel and greatest with the bipolar instruments, with a monopolar instrument falling between the 2.
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