1. A STUDY ON DIFFERENT ENERGY SOURCES
USED IN TOTAL LAPAROSCOPIC
HYSTERECTOMY
BY :DR. PREM S PATEL
RESIDENT DOCTOR
OBSTETRICS AND GYNAECOLOGY DEPARTMENT
GCS MEDICAL COLLEGE,
HOSPITAL AND RESEARCH CENTER.
PG GUIDE:DR DIVYESH PANCHAL
PROFESSOR
OBSTETRICS AND GYNAECOLOGY DEPARTMENT
GCS MEDICAL COLLEGE
HOSPITAL AND RESEARCH CENTER.
2. Executive Summary of Project:
A number of energy sources are used in gynecologic laparoscopy.
Monopolar electrosurgery, bipolar electrosurgery, advanced bipolar devices, ultrasonic
energy and various types of lasers are some of the technologies used nowadays to facilitate
surgeons tasks during laparoscopic operations.
A lack of basic knowledge or ignorance of principles of electrosurgery and equipment
among obstetricians and gynecologists is reported.
As a result thermal injuries during laparoscopic electrosurgery occur, which frequently
lead to significant morbidity and mortality and medicolegal actions.
It is important though that surgeons have an understanding of the biophysics of these
technologies in order to understand their limitations and potential dangers and to utilize the
most appropriate energy source in the appropriate clinical setting to minimize the risk of a
potential complication.
This thesis provides an overview of the basic principles of these energy sources, the tissue
effects and the complications that may arise.
It aims to highlight any potential advantages or disadvantages of various energy sources
and help surgeons to achieve better knowledge of their instrumentation.1
Field of research :
Hysterectomy, Minimally Invasive Surgery, Energy Sources used in Total Laparoscopic
Hysterectomy
3. INTRODUCTION
Hysterectomies are one of the most common surgical procedures in the field of
Obstetrics.
For decades, abdominal and vaginal approaches accounted for the vast majority of
hysterectomies.
The advent of better laparoscopic technology resulted in the first total laparoscopic
hysterectomy (TLH) in 1989. Use of TLH has steadily increased in the last 20 years.
Minimally Invasive Surgeries have also undergone significant advancements and
changed the way Total Laparoscopic Hysterectomies are carried out.
Hemostasis is essential during laparoscopic operations to ensure a clear view of the
operating field and reduce the possibility of converting to an open procedure.
In the past, materials like clips, sutures and stapling devices were used for maintaining
hemostasis but due to difficulties like repeated applications, displacement and cost, these
were abandoned after a while
Monopolar and Bipolar energy are commonly used energy sources in TLH these days.
Along with advent in energy sources, newer devices became available.
Advanced bipolar devices with tissue feedback monitoring and Devices that use
ultrasonic technology are now available.
Comparison between these energy sources will provide insight into the intra-operative
and post-operative complications and recovery. 2
4. RESEARCH QUESTION :
What are the Different Energy Sources used in Total Laparoscopic Hysterectomy and
assessment of its safety and shortcomings?
AIM :
To compare different energy sources used in Total Laparoscopic Hysterectomy and to
determine their advantages and disadvantages in Intra-operative and Post-operative
period.
OBJECTIVES :
PRIMARY OBJECTIVE:
To Compare Blood Loss, Operating Time, Recovery Time & Complications encountered
in Post-Operative period in women operated with different energy sources in Total
Laparoscopic Hysterectomy.
SECONDARY OBJECTIVE:
To find out the Benefits and Shortcomings of Different Energy Sources used in Total
Laparoscopic Hysterectomy.
5. METHODOLOGY
STUDY DESIGN : Cross Sectional Study
STUDY POPULATION : Patients who are admitted and operated for Hysterectomy at
Gynaecology Department, GCSMCH & RC.
STUDY PERIOD : 2022 TO 2024
STUDY SUBJECTS :
1 ) INCLUSION CRITERIA : Patients operated by Total Laparoscopic Hysterectomy.
2 ) EXCLUSION CRITERIA :
1) Patients operated by Abdominal Hysterectomy (AH).
2) Patients operated by Vaginal Hysterectomy (VH).
3) Patients operated by Laparoscopically assisted Vaginal Hysterectomy (LAVH).
4) Patient planned for Total Laparoscopic Hysterectomy which got converted to
Abdominal Hysterectomy Intra-operatively.
6. METHODS OF COLLECTION OF DATA AND DETAILS
OF STUDY VARIABLES:
•A Cross-Sectional Study will be carried out at Department of Obstetrics and
Gynaecology, GCS Medical College, Hospital and Research Centre, Ahmedabad.
•Women who are admitted and operated for Total Laparoscopic Hysterectomy coming
for follow-up will be included in our study.
•At the time of follow-up, Patients would be evaluated for the type of energy source
used during the operation and will be then be checked for the
1)Blood loss,
2)Operating time,
3)Post-op Pain
4)Post-op Recovery time and
5)Complications encountered in Post-operative period
based on their OT Notes and Discharge Summary.
•Energy sources included would be
1)BIPOLAR ENERGY,
2)ADVANCED BIPOLAR ENERGY(LIGASURE) AND
3)ULTRASONIC ENERGY (HARMONIC SCALPEL).
7. STATISTICALANALYSIS PLAN :
1)BLOOD LOSS: BLOOD COLLECTED IN SUCTION DRAIN.
2)OPERATING TIME: TIME TAKEN FROM BEGINNING TO THE END OF
SURGERY.
3)POST-OP RECOVERY: NUMBER OF DAYS REQUIRED FOR PATIENT TO
TIME MOBILISE AND GET DISCHARGED.
4)POST-OP PAIN : VISUAL ANALOGUE SCALE
5)COMPLICATIONS IN
POST-OP PERIOD.
9. PROFORMA (CONTD.)
•PULSE :
•BP :
•RS :
•CVS :
•PA EXAMINATION :
•PS EXAMINATION :
•PV EXAMINATION :
•BLOOD LOSS :
•ENERGY SOURCE USED :
•OPERATING TIME :
•POD AT DISCHARGE :
•DAY OF MOBILISATION :
•PAIN SCORE :
•DRESSING SITE :
•HPE DIAGNOSIS :
10. REFERENCES
1 - Energy sources in gynecologic laparoscopic surgery / http://hjog.org/?p=1855 /
Nikolaos Kathopoulis, Athanasios Protopapas, Ioannis Xatzipapas, Panagiotis
Antsaklis, Dimitrios Zacharakis, Konstantinos Samartzis, Konstantinos Kipriotis,
Dimitrios Loutradis
2 - Laparoscopic Hysterectomy ,Medscape ,Sara S Lange, MD Resident Physician,
Department of Obstetrics/Gynecology, Carolinas Medical Center, Robert V Higgins,
MD Professor, Department of Obstetrics/Gynecology, Division of Gynecologic
Oncology, Medical College of Georgia at Augusta University
