Comparative Analysis of Vaginal Cuff Dissection Outcomes in Laparoscopic Hysterectomy: Monopolar Hook vs. Harmonic Scalpel

Background & Objective: This study aimed to compare the outcomes of vaginal cuff separation using monopolar hook or harmonic scalpel in laparoscopic hysterectomy.Materials & Methods: A retrospective analysis was conducted on 210 women who underwent laparoscopic hysterectomy between 2022 and 2024. A total of 105 cases for each surgical method were randomly selected from patient records. Demographic and clinical data were extracted from medical records and analyzed using IBM SPSS version 26. P-value < 0.05 was deemed as statistically significant.Results: The mean age in the harmonic and monopolar groups was 24.76 (±5.41) and 25.75 (±4.64) years, respectively. There were no statistically significant differences between the groups in terms of age, BMI, hospitalization, history of previous abdominal surgery, preoperative hemoglobin levels, and hormone therapy (P>0.05). The mean postoperative hemoglobin level in the harmonic group (11.83 ± 1.26) was significantly higher than in the monopolar group (9.04 ± 1.13) (P<0.001). The average duration of vaginal cuff separation was significantly shorter in the monopolar group (22.24 ± 4.59) compared to the harmonic group (28.70 ± 5.93) (P<0.001). Postoperative complications, particularly vaginal lacerations, were less frequent in the harmonic group (45.7%) than in the monopolar group (60%) (P=0.015). The incidence of incidental findings, especially endometriosis, was lower in the harmonic group (12.4%) compared to the monopolar group (23.8%) (P=0.031). No cases of vaginal cuff dehiscence were observed in either group.Conclusion: This study demonstrated that vaginal cuff separation using harmonic scalpel in laparoscopic hysterectomy is associated with better outcomes compared to monopolar hook.