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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Ligasure versus Traditional Suturing in Total Abdominal Hysterectomy: A Retrospective Observational Study
Correspondence Address :
Dr. Urvashi Jainani,
Dr D. Y. Patil Medical College, Hospital and Research Centre, Pune-411018, Maharashtra, India.
E-mail: urvashijainani005@gmail.com
Introduction: Gynaecological procedures may be performed via vaginal, abdominal, or minimally invasive approaches, such as laparoscopy, hysteroscopy, and robotic surgery. Abdominal hysterectomy, a prevalent major surgical intervention, is linked to significant complications, notably bleeding and postoperative pain. The invention of Ligasure represents a pivotal milestone in the field of gynaecology.
Aim: To compare the effectiveness of Ligasure and traditional suturing during total abdominal hysterectomy.
Materials and Methods: A retrospective observational study was conducted in Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India, from March 2022 to September 2023. A total of 34 patients scheduled for elective abdominal hysterectomy were enrolled and divided into two equivalent groups comprising Ligasure (group A) and conventional suturing (group B). Comprehensive preoperative assessments and preparations were done for all participants. Subsequent documentation and comparison of operative and postoperative outcomes, focusing primarily on parameters such as surgical duration, blood loss, and postoperative complications, were done between the two groups. Student’s t-test was used to compare surgical time and blood loss between group A and group B.
Results: The mean age of participants in the Ligasure group was 43±4.5 years, and in the suture group was 45±5 years. The difference in BMI between the two groups was not significant. The surgical duration in the Ligasure group was significantly shorter (p-value=0.0002) compared to the conventional suturing group (53.8±6.7 minutes and 64.3±7.62 minutes, respectively). Furthermore, the Ligasure group showed a significant reduction (p-value<0.0001) in blood loss (156.4±31.3 mL and 261.6±36.8 mL, respectively). There was no significant difference (p-value=0.2990) in postoperative haemoglobin levels (11.6±1.2 g/dL and 11.2±1 g/dL, respectively).
Conclusion: The use of Ligasure proves to be an efficient approach in abdominal hysterectomy. A reduced duration of surgery and a significant decrease in blood loss were observed with this procedure.
Blood loss, Operative time, Robotic surgery
The prevalence of hysterectomy in India stands at 3.2%, with higher rates observed in rural areas (3.4%) compared to urban regions (2.7%) (1). There are several causes underlying the need for hysterectomy; however, common reasons for hysterectomy include excessive bleeding, uterine disorders, myomas/cysts, and uterine prolapse, among other unspecified causes (2). Given that bleeding is a frequent surgical complication, employing effective haemostatic techniques is crucial. Efficient, painless, and thorough vascular sealing remains a critical consideration during abdominal hysterectomy, especially when dealing with the extraction of large vessels. Various techniques are employed to secure the vascular pedicle in this procedure, encompassing traditional suturing and mechanical ligation utilising the electrothermal bipolar vascular sealing system, known as Ligasure (3). While surgical suturing and ligation are the conventional approaches for stabilising the vascular pedicle, the suturing process involves clamping, cutting, and ligation, leading to prolonged hysterectomy durations and increased blood loss. In contrast, Ligasure utilises a regulated high-power current at a lower voltage for liquefying collagen and elastin to ensure the fusion of the vascular layers permanently (4),(5),(6). This instrument is also equipped with a feedback control, featuring an automatic “off” switch, to safeguard the tissue from burning due to overcoagulation when impedance reaches a hazardous level (4).
The comparison of Ligasure and traditional suturing in total abdominal hysterectomy is a multifactorial research question that has been widely studied, with results being inconclusive. This study was done to analyse the application of Ligasure against traditional suturing during total abdominal hysterectomy, evaluating parameters such as the duration of the procedure, blood loss during the procedure, and the occurrence of intraoperative complications and postoperative pain. This study adds to the repertoire of studies regarding the efficacy of Ligasure.
This retrospective observational study was conducted at Dr. D. Y. Patil Medical College, Hospital, and Research Centre in Pune, Maharashtra, India, spanning from March 2022 to September 2023. The study was approved by the Institute’s Ethical Committee (IEC) (Reference No. I.E.S.C./W/48/2024). The study encompassed patients admitted and scheduled for an elective hysterectomy.
Inclusion criteria: Females with benign uterine pathology, uterine size <14 weeks, age between 40 and 50 years, Body Mass Index (BMI) equal to or less than 35 kg/m² were included in the study.
Exclusion criteria: Females with malignant uterine pathology, pelvic inflammatory disease, uterine size >14 weeks, history of diabetes mellitus, history of using anticoagulant drugs, haemoglobin <10 g/dL, patients with implanted electronic devices were excluded from the study.
Data collection: The population under study included two groups, each comprising 17 patients: Group A (Ligasure) included participants who benefited from bipolar vessel sealing with Ligasure; group B (conventional suturing) included the participants who underwent hysterectomy with conventional suturing.
Study Procedure
Comprehensive preoperative assessment was done, which included taking a history followed by a clinical evaluation, and subsequent routine laboratory investigations to ensure suitability for the procedure. All hysterectomies were performed under general anaesthesia by the same surgeon. Povidone iodine solution was used to disinfect the vulva and perineum after the patients were positioned in the supine position. A Foley catheter was inserted, and the abdomen was prepped up to the xiphoid process.
In group A, abdominal hysterectomy was conducted through a Pfannenstiel incision in a slight Trendelenburg position. The round ligament, tubo-ovarian ligament (if bilateral salpingo-oophorectomy was planned), or infundibulopelvic ligament (if ovaries were to be retained), along with the cardinal ligament and uterosacral ligament, were clamped, relaxed for tissue traction, sealed, and then divided using Ligasure. The closure of the vaginal cuff was secured with a single-layer continuous running suture.
In group B, the same procedural steps were executed using conventional clamping and suturing techniques with Kocher clamps and sterile synthetic absorbable braided polyglactin 910 sutures. The closure of the vaginal cuff was secured with a single-layer continuous running suture.
Upon achieving haemostasis, the rectus muscle was closed with simple interrupted sutures using polyglactin 910, followed by the closure of the rectus sheath. The skin was closed with Ethilon 2-0 sutures.
Outcomes assessed: This study provides insightful information on the safety and efficacy of Ligasure in comparison to traditional suturing by assessing key outcomes such as operation time, blood loss, and postoperative complications. The reduction of intraoperative blood loss is crucial for enhancing patient recovery. In this study, blood loss was measured by the difference in preoperative and postoperative haemoglobin levels, a standard method for assessing intraoperative blood loss.
Statistical Analysis
Student’s t-test was used to compare the surgical time and blood loss between group A and group B. A chi-square test was used to analyse the postoperative complications in group A and group B. The data were analysed using GraphPad Prism 10. The p-value was considered significant at <0.05.
The mean age of participants in the Ligasure group was 43±4.5 years, while the mean age of participants in the suture group was 45±5 years. There was also no significant difference in the BMI between the two groups (Table/Fig 1).
Abnormal Uterine Bleeding (AUB) was the most frequent (41%) indication for hysterectomy in the study population, accounting for 35% in group A and 47% in group B, followed by fibroids, accounting for 29% in the total population, with 35% in group A and 23% in group B (Table/Fig 2).
Surgery time in group A was significantly less when compared to group B (p-value 0.0002). The loss of blood during the surgery was also significantly reduced in group A when compared with group B (p-value<0.0001) (Table/Fig 3).
There were no significant complications during the procedures in both groups. There was a single instance of bladder injury in group B, while no instances were reported in group A. However, one event of ligature slippage was reported in group A, and no such cases were reported in group B (Table/Fig 4).
It was observed that 24% of patients in group B had wound dehiscence, while only 6% of patients in group A had this complication (Table/Fig 5). However, the association was tested using a Chi-square test and was not found to be statistically significant.
Total abdominal hysterectomy is a common surgical procedure performed for various gynaecological indications, such as uterine fibroids, endometrial cancer, and uterine prolapse. However, the success of the procedure is attributed to the effective surgical methodology. Recently, Ligasure has evolved to be a safe and effective approach over the traditional suturing method in such cases (7),(8). Present study found that the surgery time in group A was significantly less compared to group B (p-value 0.0002). The blood loss during the surgery was also significantly reduced in group A compared with group B (p-value=<0.0001). Several other studies have explored the effectiveness of Ligasure and traditional suturing. A study by Ulubay M et al., showed a significant decrease in intraoperative time in Ligasure group compared to the conventional suturing method (p-value=0.016) (7). Another study by Singh H et al., found that Ligasure significantly reduced operative time compared to traditional suturing (8). Furthermore, in a study by Essadi F et al., the Ligasure group had a mean procedure time of 39.6 minutes, while the conventional suturing group had a mean operative time of 62.7 minutes (p-value=0.05) (9). A randomised trial by Dubey P et al., reported that the Vessel Sealing Arm had a significantly reduced mean operative time of 26.97±8.92 minutes compared to 33.67±8.62 minutes in the Suture Ligature Arm (p-value=0.005). Additionally, there was a significant reduction in intraoperative blood loss, with 111±53.31 mL in the vessel sealing arm compared to 320±193.90 mL in the suture ligature arm (p-value=0.001) (10). Several other studies concur with the findings that vessel sealing may offer advantages over traditional suture ligature techniques in terms of both operative time and blood loss during surgery (11),(12). Present results were in concurrence with these results.
The efficacy of Ligasure is attributed to its simultaneous cut and seal ability, and faster haemostasis which not only reduces operative time but also prevents excessive blood loss. Consistent with present study results, Essadi F et al., and Singh H et al., showed that patients undergoing a Ligasure procedure had significantly less blood loss compared to the conventional suturing method when securing the pedicle during a hysterectomy. Singh H et al., showed that in the Ligasure group, 76% of patients experienced significantly less blood loss (<50 mL) compared to 60% of patients in the conventional suture group (8). The results from the study by Essadi F et al., indicated that in the Ligasure group, the mean blood loss was significantly less, with an average of 80.6 cc compared to 126.7 cc in the other group (p-value<0.05) (9).
A randomised clinical trial conducted by Shady NW et al., found no significant difference in complications during the surgery. However, the study revealed that Ligasure effectively reduced postoperative pain compared to the conventional suturing group (13). In contrast, Essadi F et al., reported fewer complications in the Ligasure group than those found in the conventional suturing group (9). This difference needs to be carefully investigated to have a clear understanding of associated complications.
This study provides insightful information on the safety and efficacy of Ligasure compared to traditional suturing. Ligasure has garnered attention for its potential advantages in surgical procedures. Present study data strongly agrees with existing literature indicating that Ligasure can offer benefits such as reduced operative time, decreased blood loss, and fewer postoperative complications. However, while these advantages are promising, future follow-up studies are necessary to evaluate the intricate parameters of Ligasure further. Specific aspects that require more research include long-term outcomes, cost-effectiveness, and its efficacy in different surgical contexts and patient populations.
Limitation(s)
High BMI (≥25 kg/m2) of patients, large uterine size, and a history of previous pelvic surgery with possible intraperitoneal adhesions, which can theoretically increase the operative time, were not considered in this study. The small sample size was also one of the main limitations of this study. The retrospective nature of the study was an inherent limitation.
Although procedure time and blood loss have consistently been shown to be reduced in the Ligasure method compared to traditional suturing, it is imperative to meticulously assess the associated complications of the procedure. Various factors, including the size of the study population, institutional resources, and the proficiency of the surgeon, significantly influence the study’s outcomes. Consequently, well-structured clinical trials conducted across multiple institutions would be more efficacious in providing a definitive assessment of the safety and efficacy of the Ligasure procedure in comparison to the traditional suturing method.
DOI: 10.7860/JCDR/2024/69258.19745
Date of Submission: Dec 29, 2023
Date of Peer Review: Feb 19, 2024
Date of Acceptance: Jun 20, 2024
Date of Publishing: Aug 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 30, 2023
• Manual Googling: Feb 21, 2024
• iThenticate Software: Jun 19, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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