Innovations Stem Blood Loss in Hysterectomy.

CHICAGO -- Innovations aimed at refining abdominal hysterectomy are significantly stemming the loss of blood during the procedure, experts said at the annual meeting of the American College of Obstetricians and Gynecologists.

Among the estimated 390,000 abdominal hysterectomies performed annually in the United States, hemorrhage requiring transfusion is the leading major complication, said Dr. Cynthia 0kin of the University of Pittsburgh.

In a study involving 50 patients undergoing total abdominal hysterectomy, those who were randomly assigned to undergo hemostasis using a device called LigaSure lost an average of 74.2 cc of blood, compared with 118.7 cc among patients who received conventional ligation, said Dr. Raffaele Bruno of Lahey Clinic, Burlington, Mass.

Dr. Bruno holds no financial interest in LigaSure or Valleylab Inc., the Boulder, Colo.-based manufacturer of the device.

The LigaSure technique uses much lower voltages and higher current flows than conventional ligation with an electrosurgical generator. With the LigaSure device, collagen and elastin are denatured to the point where the intimal layers of the vessel wall can be compressed and collapsed into a single layer. The lumen of that blood vessel is completely obliterated, Dr. Bruno explained.

In contrast, traditional methods of ligation use much higher voltages and lower current flows, which create more heat in the vessel wall. The wall of the lumen then shrinks, disrupting blood flow. This in turn causes a clot to form in the proximal section of the vessel. It's this clot that actually creates the hemostasis, he said.

During the entire LigaSure procedure, the level of impedance in the vessel tissue is automatically measured in the jaws of a clamp. The amount of energy delivered to the vessel wall adjusts depending on the ...