Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: what is the clinical effectiveness and cost effectiveness of advanced electrosurgical bipolar vessel sealing compared with standard care for controlling intraoperative bleeding in hysterectomy? 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). 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.

Authors' results and conclusions: The evidence included in this review suggests there are some statistically significant outcomes to support the effectiveness of ABVS. Blood loss appears to be lower for abdominal hysterectomy with ABVS compared with using conventional sutures and for laparoscopic subtotal hysterectomy using ABVS compared with conventional EBVS or harmonic scalpel. Operative time during vaginal hysterectomy, and the risk of requiring a blood transfusion during abdominal hysterectomy also appear to be lower when ABVS is used. Operative time was estimated to be statistically significantly shorter with ABVS than conventional EBVS during total laparoscopic hysterectomy. Patient-reported pain seems to be lower in the first few hours after abdominal or vaginal hysterectomy with ABVS compared to with conventional suturing. However, this effect appears to diminish by one day postoperatively. There are some outcomes that appear weaker in terms of statistical significance, such as length of hospital stay and rates of complications. These outcomes seem to be similar between ABVS and comparators for all routes of hysterectomy. Patient-reported pain also appears to be similar between ABVS and other energy devices after laparoscopic hysterectomy. Overall, it appears that ABVS is non-inferior, in terms of clinical effectiveness, to conventional sutures during vaginal or abdominal hysterectomy and conventional EBVS or other energy-based vessel sealing devices during laparoscopic hysterectomy. The cost-consequence analysis conducted by HTW compared ABVS to conventional sutures in vaginal and abdominal hysterectomy, and to conventional EBVS in laparoscopic hysterectomy. Results of the analysis demonstrated cost savings when using ABVS during vaginal hysterectomy due to a reduced operating time offsetting the upfront device costs. However, cost increases were identified when using ABVS during abdominal and laparoscopic hysterectomies. Sensitivity, scenario and threshold analyses suggest that conclusions remain stable for abdominal hysterectomy, but that there is less certainty around cost implications during vaginal and laparoscopic hysterectomies.

Authors' recommendations: The evidence partially supports the adoption of advanced electrosurgical bipolar vessel sealing (ABVS) in people undergoing hysterectomy: (1) The evidence supports the routine adoption of ABVS for use during vaginal hysterectomy. (2) 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.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel felt it would be helpful to acquire data on clinical outcomes and health economic consequences, including quality of life, of the use of all ABVS devices during hysterectomies.

Project Status: Completed

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/advanced-electrosurgical-bipolar-vessel-sealing-systems-during-hysterectomy/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk