Comparison of three different hemostatic devices in laparoscopic myomectomy

Background: To compare conventional electrosurgery, LigaSure (Valleylab, Boulder, CO), and Harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) in terms of perioperative and postoperative outcomes during laparoscopic myomectomy (LM). Methods: We retrospectively studied 817 women with symptomatic fibroids who underwent LM between January 1997 and September 2015. Three different instruments were used separately during surgery. The number and weight of removed fibroids, blood loss, operative time, postoperative decrease in the hemoglobin level, and length of hospital stay were measured for statistical analysis. Results: No significant increase in complications was found in the three groups. Patients in the LigaSure and Harmonic scalpel groups had more numbers of removed fibroids, heavier fibroids removed, and higher rate of pretreatment with GnRH agonist (p < 0.001). These patients also had higher amount of intraoperative bleeding (p = 0.003) and longer operative time (p < 0.001) than those in the conventional electrosurgery group. However, no worse postoperative clinical outcome but shorter length of hospital stay was found in the LigaSure and Harmonic scalpel groups (2.1 ± 0.6, 2.0 ± 0.4 vs 2.5 ± 0.8 days, p < 0.001). Conclusion: The use of all three devices is feasible in LM. LigaSure and Harmonic scalpel can reduce the length of hospital stay without worse surgical outcomes.