الفهرس 
Aim Of The WorkOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
Abstract
Summary
A hysterectomy is the surgical removal of the uterus. Hysterectomy may be total or partial. It is the most commonly performed gynecological surgical procedure.
Some of the conditions treated by hysterectomy include uterine fibroids, endometriosis, adenomyosis ,several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and (uterine, advanced cervical, ovarian) cancer.
Hysterectomy can be performed in different ways. Traditionally, it has been performed via either abdominal incision (total abdominal hysterectomy,) or vaginal canal (vaginal hysterectomy). ”laparoscopic-assisted vaginal hysterectomy” (LAVH) has gained great popularity among gynecologists.
The art of surgical hemostasis is preventing vascular trauma while leaving the least-possible collateral tissue damage. When bleeding is encountered, the surgeon’s ability to attain hemostasis using a particular modality depends largely on how well he or she understands its technical aspects. Of course, thorough knowledge of anatomy also is crucial to prevent inadvertent damage to vital structures And so in this article we will focus on Ultrasonic scalpel, Bipolar forceps, monopolar forceps, and LigaSure.
The ultrasonic scalpel (USS) is a hemostatic surgical instrument used for incising and dissecting tissues. It works by using ultrasonic waves to denature collagen forming a coagulum. The ultrasonically activated scalpel (UAS) was introduced in clinical practice in the early (1990s) for coaptive coagulation and the cutting of blood vessels and tissues. The use of the ultrasonically activated scalpel (UAS) for vessel closure has attained widespread acceptance in many surgical fields. The mechanism involved in vessel coagulation by (UAS) are related to the compression of the exposed tissues and to heat generation by internal tissue friction. When ultrasonic energy is applied to tissues, it changes their structure so as to make a new extracellular matrix
Bipolar electrosurgery consolidates an active electrode and return electrode into an instrument with 2 small poles. These poles can be the tines of a forceps, blades of a scissors. The output typically used is the low-voltage “cut”current. Localization of current between the poles offers distinct advantages.
In monopolar surgery, electrical current created in the electrosugical unit [ESU] passes through a single electrode to the tissue, causing the desired tissue effect (eg, fulguration, dessication, or vaporization).
The ligasure is a bipolar clamping device utilized in open and laparoscopic surgery for producing hemostasis in large vascular pedicles.
LigaSure provides a combination of pressure and energy which reforms the collagen and elastin in vessel walls to form an autologous seal and thereby achieving complete haemostasis. It permanently fuses vessels up to and including seven mm in diameter and tissue bundles without dissection or isolation.
The aim of this study is to assess the safety and efficacy, and compare between ultrasonic scalpel, monopolar forceps, bipolar forceps and LigaSure in hysterectomy.
The present study was carried out on 60 patients who was underwent hysterectomy with:
• LigaSure (GROUP-A): 15 patients.
• Bipolar forceps (GROUP-B): 15 patients.
• Ultrasonic scalpel (GROUP- C): 15 patients.
• Monopolar forceps (GROUP-D): 15 patients.
And the safety and effectiveness of the four different energy sources in hysterectomy are evaluated.
Our results showed that:
• Ligasure group showed a significant lower mean value of blood loss followed by bipolar group (although the difference between both was non significant), then ultrasonic group & lastly monopolar group (the difference between .The last two group was non significant (p > 0.05).
• Ultrasonic scalpel group showed significant higher mean operative time than other maneuvers followed by monopolar forceps (although the difference between both was no significant) then bipolar forceps group where ligasure group showed the lowest operative time.
• Ligasure group showed a lower significant mean value of Hb% descent than other maneuvers followed by bipolar forceps group then ultrasonic group and lastly monopolar forceps group; (the difference between the two latter was non significant) .
• There is non significant difference between different maneuvers regarding complications.