Comparison of the efficacy and safety of two advanced vessel sealing technologies in total laparoscopic hysterectomy Burcu Aykan Yuksel , Burak Karadag and Baris Mulayim Department of Obstetrics and Gynecology, Saglik Bilimleri University, Antalya Education and Research Hospital, Antalya, Turkey Abstract Aim: Adequately powered, randomized controlled studies evaluating efficacy and safety of advanced bipo- lar energy devices in gynecologic laparoscopic surgery are very few. We aimed to compare the two most commonly used devices in total laparoscopic hysterectomy. Methods: This randomized controlled trial was carried out in the department of obstetrics and gynecology in an education and research hospital. One hundred thirty-two women who underwent total laparoscopic hysterectomy for benign indications were included. Women with age younger than 18 years, suspected malignancy, stage 3–4 endometriosis and cervical/intraligamentary leiomyoma were excluded. Patients were randomized preoperatively to LigaSure or Articulating Enseal. One experienced surgeon performed all operations. Results: LigaSure was used in 67 patients and Enseal was used in 65 patients. Primary outcomes of the study were operative time (time from start of sealing and transection of the round ligament until completion of colpotomy) and total operative time (time from skin incision to skin closure). Secondary outcomes were intraoperative blood loss (blood lost during operative time period) and perioperative complications. Opera- tive time was significantly shorter in LigaSure group (P = 0.001). Total operative time, intraoperative blood loss and perioperative complications were similar. When two groups were further classified according to uterine weight taking 300 g as cut-off value, operative time was significantly shorter in LigaSure group in both subgroups (P = 0.003 and P = 0.007). Conclusion: LigaSure use in total laparoscopic hysterectomy shortens operative time when compared with Enseal; without an apparent increase in intraoperative blood loss and perioperative complications. On the other side, total operative time remains unaffected. Key words: advanced bipolar energy device, laparoscopy, operative time, total laparoscopic hysterectomy, uterine weight. INTRODUCTION The evolution of electro-surgery begins at the end of nineteenth century with the use of monopolar energy which, towards the end of twentieth century, was followed by invention of conventional bipolar devices and continued by innovation of advanced bipolar energy devices. 1 Monopolar energy is widely used in laparoscopic procedures because of its low cost and availability but when compared with bipolar energy, lateral thermal spread is greater, the risk of unwanted stray current Received: December 20 2018. Accepted: July 28 2019. Correspondence: Dr Burcu Aykan Yuksel, Ça glayan Mah. Fener Cad. Maki-1 Evleri Sitesi, B Blok, No: 2B/9, Muratpas¸a/Antalya, Turkey. Email: burcuaykan@gmail.com 1 © 2019 Japan Society of Obstetrics and Gynecology doi:10.1111/jog.14096 J. Obstet. Gynaecol. Res. 2019