Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-assisted ovariohysterectomy

Objective— To describe the safety, surgical time, and complications associated with 3 techniques for achieving hemostasis during laparoscopic-assisted ovariohysterectomy (LAOVH).
Study Design— Prospective, randomized clinical trial.
Animals— Female dogs ( n =30).
Methods— Dogs were randomly assigned to 1 of 3 methods for achieving ovarian pedicle hemostasis during LAOVH: extracorporeal modified Roeder knot application (suture group), metal clip application using a multifire 10 mm laparoscopic clip applier (clip group), or use of a novel 5 mm bipolar vessel-sealing device (vessel-sealing group). In all dogs a 3 median portal technique was used.
Results— Controlling for the dogs' bodyweights, there was a significant association between surgical time and which method for hemostasis was used. This association was different when comparing the first 5 procedures using each method to the second 5. For a 20 kg dog, the surgical time (95% CI) for the first 5 procedures was 80 (69–91), 68 (57–79), and 33 (21–45) minutes for the suture, clip, and vessel-sealing groups, respectively. For the second 5 procedures surgical time was 71 (60–81), 50 (39–60), and 40 (29–51) minutes. Pedicle hemorrhage occurred in all dogs in the clip group, 3 dogs in the suture group, and none of the dogs in the vessel-sealing group although in all cases was considered hemodynamically inconsequential. All dogs recovered uneventfully.
Conclusions— All methods of hemostasis were safe for pedicle sectioning. A learning curve exists for clip and suture methods.
Clinical Relevance— Use of a vessel-sealing device significantly shortens surgical time and provides excellent hemostasis during LAOVH.