Electrothermal bipolar coagulation decreases the rate of red blood cell transfusions for pelvic exenterations

Background: We evaluated whether electrothermal bipolar coagulation (Ligasure) for pelvic exenterations decreases operative morbidity. Methods: All cases of pelvic exenterations, for all malignancies, performed at Moffitt Cancer Center from 1999 to 2008, were identified through retrospective review of medical records. Estimated blood loss (EBL), transfusion, operative time, hospital stay, and complications were compared between Ligasure cases and non-Ligasure cases. Results: Seventy-five patients underwent identified. Ligasure was used in 29/75 (39%) cases and standard techniques in 46/75 (61%) cases. Primary malignancy was gynecologic in 31/75(40%) cases (18/29, 62% Ligasure cases, 13/46, 26% non-Ligasure cases). Patients undergoing gynecologic exenteration received fewer intraoperative packed red blood cell (PRBC) transfusions in the Ligasure group (mean = 2.8 U), compared to the non-Ligasure group (mean = 3.8 U; P<0.0001). The EBL was less for Ligasure cases (1,815 ml vs. 2,205 ml; P = 0.4). For all patients, Ligasure cases had lower mean transfusion (2.7 U vs. 3.2 U; P = 0.32), and EBL (1,662 ml vs. 1,843 ml; P = 0.5). The mean operating time was similar (492 min vs. 502 min). There were no cases of re-operation for hemorrhage in either group. Conclusions: Use of electrothermal bipolar coagulation for gynecologic exenterative surgery is associated with significantly lower blood transfusions, and may decrease blood loss and transfusion in non-gynecologic exenterative surgery.