An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery.

Purpose: We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery.

Study Design: Initial studies compared the LigaSure Impact and Harmonic ACE + 7 Shears in the efficiency of hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term = 145;  = 7) underwent hysterotomy using either device. Hysterotomy edges were resected, and thermal injury extent was determined by histopathological assessment. Upon determining a superior device, subsequent studies compared this to the AutoSuture Premium Poly CS*-57 Stapler in uterine healing. Pregnant ewes ( = 6) at an EGA of 87 to 93 days underwent 6-cm hysterotomy in each gravid horn with either the stapler ( = 5) or Harmonic ( = 5) followed by closure and animal recovery. After 37 to 42 days, uterine healing was assessed by evaluating tensile strength and histopathology.

Results: Thermal damage was more extensive with the LigaSure ( = 11 hysterotomies) than with the Harmonic ( = 11; 5.6 ± 1 vs. 3.1 ± 0.6 mm;  < 0.0001);therefore, the Harmonic was selected for healing studies. Gross scar appearance and tensile strength were the same between the Harmonic and stapler. The stapler caused more fibrosis (4/7 samples with "moderate" fibrosis vs. 0/8 with the Harmonic;  = 0.02).

Conclusion: The Harmonic ACE + 7 caused less thermal injury than the LigaSure Impact and performed similar to the CS*-57 Stapler in uterine healing with continued gestation.