Advanced electrosurgical bipolar vessel sealing systems during hysterectomy
Topic Status Complete
Use of advanced electrosurgical bipolar vessel sealing systems during hysterectomy compared to other methods for control of bleeding.
Outcome of the appraisal
The evidence partially supports the adoption of advanced electrosurgical bipolar vessel sealing (ABVS) in people undergoing hysterectomy:
- The evidence supports the routine adoption of ABVS for use during vaginal hysterectomy.
- Whilst ABVS shows promise for use during abdominal hysterectomy and laparoscopic hysterectomy, the evidence is insufficient to support routine adoption. ABVS could be considered selectively where clinical judgement supports its use in complex cases, such as in those with more difficult pelvic access.
The evidence identified indicated operative time is shorter when ABVS is used during vaginal hysterectomy and HTW’s cost-consequence analysis estimated it is marginally cost saving compared to suturing.
Though the effectiveness evidence indicated blood loss and the risk of requiring blood transfusion were lower when ABVS is used during abdominal hysterectomy, the cost-consequence analysis estimated it to be cost incurring compared with suturing.
Blood loss was found to be lower when ABVS is used during subtotal laparoscopic hysterectomy and operative time was shorter during total laparoscopic hysterectomy, however, ABVS use was estimated to be cost incurring for laparoscopic hysterectomy compared to conventional electrosurgical bipolar vessel sealing (EBVS).
HTW recommends the collection of data on clinical outcomes and health economic consequences, including quality of life, of the use of all ABVS devices in Wales, reflecting use in both routine and complex clinical contexts.
Why was this topic appraised?
Hysterectomy is a surgical procedure to remove the uterus; it is carried out to treat various issues affecting the female reproductive system. It is important to control intraoperative bleeding during hysterectomy and the current standard of care for vaginal and abdominal hysterectomies is suturing, monopolar electrosurgery, or conventional electrosurgical bipolar vessel sealing (EBVS), whilst standard of care for laparoscopic hysterectomies is advanced EBVS (ABVS).
ABVS improves on conventional EBVS by using higher current and lower voltage, which allows for tissue cooling, and by measuring the resistance of the tissue to the flow of electrical current (tissue impedance). By measuring tissue impedance, the devices can automatically switch off the current when haemostasis is achieved and limit thermal spread to surrounding tissue. ABVS devices can be used on vessels and tissue bundles up to 7 mm thick, compared to just 2 mm for conventional EBVS. HTW has appraised ABVS as it has previously been assessed to have significant potential to be cost saving and may offer improved clinical outcomes over current standard of care.
This topic was suggested to HTW via the NHS Innovation Service.
Plain language summary
A hysterectomy is a surgical procedure during which the womb is taken out. The most common reasons for having a hysterectomy include heavy periods, pelvic pain, cancer or prolapse. During the surgery, there is a need to control bleeding as the surgeon operates. There are several ways in which bleeding can be controlled.
Electrosurgical bipolar vessel sealing systems (EBVS) control bleeding by sealing the blood vessels with electric current. Advanced EBVS (ABVS) systems use higher currents and lower voltage, and measure tissue resistance to electrical flow to adjust these, which allows tissue cooling during use and reduces heat damage to surrounding tissues. This is proposed to reduce the amount of bleeding during surgery, leading to less pain for patients during recovery and shorter hospital stays.
Health Technology Wales looked for evidence on advanced EBVS systems during hysterectomy. The evidence partially supports the adoption of ABVS in people undergoing hysterectomy.
Guidance
EAR065 03.2025
Evidence Appraisal Report
EAR065 03.2025
Topic Exploration Report
TER423 02.2024 (superseded by EAR065 03.2025)
Health Technology Wales Partners
