Laparoscopic-assisted vaginal hysterectomy using the laparosonic coagulating shears.

The use of the Laparosonic Coagulating Shears (LCS) for laparoscopic-assisted vaginal hysterectomy (LAVH) was evaluated in three women. The indications for surgery included chronic pelvic pain, adhesions, endometriosis, symptomatic uterine fibroids, and abnormal bleeding. The entire laparoscopic portion of the LAVH was performed with the LCS. All three patients had an uneventful postoperative course, and continue to do well one year postoperatively. The harmonic scalpel produces surgical incisions with concomitant hemostasis. With the introduction of the LCS, larger vessels can be managed safely. The LCS produces less charring and less thermal tissue injury, reduces postoperative adhesions, and promotes faster healing. The cavitational effect facilitates dissection, and the minimal heat production and absence of current through the patient contribute to safety. Ultrasonic activated technology is easy to use, cost effective, and affords the surgeon a greater margin of safety. This is only a preliminary report, and further study is needed, but the benefits of ultrasonically activated technology and the LCS are readily apparent.