Article Data

  • Views 1014
  • Dowloads 199

Original Research

Open Access

Vaginal hysterectomy using the ERBE BiClamp® bipolar vessel sealing system as a surgical approach for endometrial cancer—single surgeon experience from a district general hospital

  • Niamh Haughey1,*,
  • James P. Beirne1
  • Gillian V. Blayney2
  • Lynsey Hinds2
  • Declan Quinn2
  • Donald Chandranath2
  • Gary J. Dorman2

1Trinity St James’s Cancer Institute, St James’s Hospital, D08 NHY1 Dublin, Ireland

2Antrim Area Hospital, BT41 2RL Antrim, Northern Ireland

DOI: 10.22514/ejgo.2022.055 Vol.43,Issue 6,December 2022 pp.26-33

Submitted: 17 May 2022 Accepted: 27 June 2022

Published: 15 December 2022

*Corresponding Author(s): Niamh Haughey E-mail:


Uterine cancer is the most common gynaecological malignancy with increasing incidence due to rising ageing, increasing obesity within the population and falling rates of hysterectomy for benign disease. European and British guidelines advocate a minimally invasive surgery (MIS) even in patients with high-risk endometrial cancer (EC). The standard surgical procedure is total hysterectomy with bilateral salpingo-oophorectomy. Our study examines vaginal hysterectomy (VH) performed using the ERBE BiClamp® bipolar vessel sealing system as a surgical approach for EC following studies demonstrating its safety in VH for benign disease. Retrospective review of a single surgeons practice of patients booked for VH as the surgical treatment of EC (2011–2019). Patients’ electronic records and paper charts were reviewed. Primary outcome was oncological safety and secondary outcomes were intra-operative blood loss, complications encountered, and length of hospital stay (LOS). The comparison group where previously studied patients undergoing BiClamp® VH by the same surgeon for benign/pre-malignant conditions. A total of 127 patients were included (median age 64 years, median BMI 32 kg/m2). Mean Hb drop was 9.3 g/L. 50.4% of patients were discharged on the 1st post-operative day and 82.7% by day 2. A total of 35 patients received adjuvant treatment. There were 2 cases of vault recurrence and 2 patients died from disease progression. Overall, 5 year survival was 92.9% with the majority of deaths dues to cardiac causes or a separate malignancy. The rate of disease progression was 3.1%. This study suggests that BiClamp® VH is an oncologically safe procedure and could be considered as an alternative MIS approach in the cohort of patients who are not suitable for laparoscopic or robot-assisted staging surgery. The technique affords a short operative time, minimal bloods loss, short LOS with acceptable surgical outcomes and similar oncologic outcomes to other surgical approaches.


Endometrial cancer; Vaginal hysterectomy; BiClamp®

Cite and Share

Niamh Haughey,James P. Beirne,Gillian V. Blayney,Lynsey Hinds,Declan Quinn,Donald Chandranath,Gary J. Dorman. Vaginal hysterectomy using the ERBE BiClamp® bipolar vessel sealing system as a surgical approach for endometrial cancer—single surgeon experience from a district general hospital. European Journal of Gynaecological Oncology. 2022. 43(6);26-33.


[1] Crosbie E, Morrison J. The emerging epidemic of endometrial cancer: time to take action. Cochrane Database of Systematic Reviews. 2014; ED000095.

[2] Parazzini F, Ricci E, Bulfoni G, Cipriani S, Chiaffarino F, Malvezzi M, et al. Hysterectomy rates for benign conditions are declining in Lombardy, Italy: 1996–2010. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2014; 178: 107–113.

[3] Cancer-Research UK. Uterine Cancer Statistics. 2022. Available at: (Accessed: 16 May 2022).

[4] Cancer-Registry NI. Uterine Cancer Statistics. 2022. Available at: (Accessed: 16 May 2022).

[5] Kurnit KC, Ward KK, McHale MT, Saenz CC, Plaxe SC. Increased prevalence of comorbid conditions in women with uterine cancer. Gynecologic Oncology. 2015; 138: 731–734.

[6] Morrison J, Balega J, Buckley L, Clamp A, Crosbie E, Drew Y, et al. British Gynaecological Cancer Society (BGCS) uterine cancer guide-lines: recommendations for practice. European Journal of Obstetrics, Gynecology and Reproductive Biology. 2022; 270: 50–89.

[7] Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecological Cancer. 2021; 31: 12–39.

[8] Janda M, Gebski V, Davies LC, Forder P, Brand A, Hogg R, et al. Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage I endometrial cancer: a randomized clinical trial. JAMA. 2017; 317: 1224–1233.

[9] Galaal K, Donkers H, Bryant A, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database of Systematic Reviews. 2018; 10: CD006655.

[10] Massi G, Savino L, Susini T. Vaginal hysterectomy versus abdominal hysterectomy for the treatment of stage I endometrial adenocarcinoma. American Journal of Obstetrics and Gynecology. 1996; 174: 1320–1326.

[11] Chan JK, Lin YG, Monk BJ, Tewari K, Bloss JD, Berman ML. Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women. Obstetrics and Gynecology. 2001; 97: 707–711.

[12] Susini T, Massi G, Amunni G, Carriero C, Marchionni M, Taddei G, et al. Vaginal hysterectomy and abdominal hysterectomy for treatment of endometrial cancer in the elderly. Gynecologic Oncology. 2005; 96: 362–367.

[13] Occelli B, Samouelian V, Narducci F, Leblanc E, Querleu D. The choice of approach in the surgical management of endometrial carcinoma: a retrospective serie of 155 cases. Bulletin du Cancer. 2003; 90: 347–355.

[14] Moscarini M, Ricciardi E, Quarto A, Maniglio P, Caserta D. Vaginal treatment of endometrial cancer: role in the elderly. World Journal of Surgical Oncology. 2011; 9: 74.

[15] Beck TL, Morse CB, Gray HJ, Goff BA, Urban RR, Liao JB. Route of hysterectomy and surgical outcomes from a statewide gynecologic oncology population: is there a role for vaginal hysterectomy? American Journal of Obstetrics and Gynecology. 2016; 214: 348.e1–348.e9.

[16] Nitschmann C, Multinu F, Bakkum-Gamez J, Langstraat C, Occhino J, Weaver A, et al. Vaginal vs. robotic hysterectomy for patients with endometrial cancer: a comparison of outcomes and cost of care. Gynecologic Oncology. 2017; 145: 555–561.

[17] Gauthier T, Huet S, Marcelli M, Lamblin G, Chêne G; French College of Obstetrics and Gyneacology (CNGOF). Hysterectomy for benign gynaecological disease: Surgical approach, vaginal suture method and morcellation: guidelines. Journal of Gynecology Obstetrics and Human Reproduction. 2015; 44: 1168–1182.

[18] American College of Obstetricians and Gynecologists. Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstetrics and Gynecology. 2017; 129: e155–e159.

[19] Committee on Practice Bulletins—Gynecology and the Society of Gynecologic Oncology Practice Bulletin No. 149: Endometrial Cancer. Obstetrics & Gynecology. 2015; 125: 1006–1026.

[20] Moss EL, Morgan G, Martin AP, Sarhanis P, Ind T. Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study. BMJ Open. 2020; 10: e036222.

[21] Cassis C, Mukhopadhyay S, Sule MM, Kuruba N. Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device. International Journal of Gynecology & Obstetrics. 2018; 142: 182–186.

[22] Chia KV, Tandon S, Moukarram H. Vaginal hysterectomy is made easier with ERBE Biclamp® forceps. Journal of Obstetrics and Gynaecology. 2007; 27: 723–725.

[23] Clavé H, Baar H, Niccolaï P. Painless vaginal hysterectomy with thermal hemostasis (results of a series of 152 cases). Gynecological Surgery. 2005; 2: 101–105.

[24] Ghirardini G, Mohamed M, Bartolamasi A, Malmusi S, Dalla Vecchia E, Algeri I, et al. Minimally invasive vaginal hysterectomy using bipolar vessel sealing: preliminary experience with 500 cases. Journal of Obstetrics and Gynaecology. 2013; 33: 79–81.

[25] Zubke W, Hornung R, Wässerer S, Hucke J, Füllers U, Werner C, et al. Bipolar coagulation with the BiClamp® forceps versus conventional suture ligation: a multicenter randomized controlled trial in 175 vaginal hysterectomy patients. Archives of Gynecology and Obstetrics. 2009; 280: 753–760.

[26] Leo L, Riboni F, Gambaro C, Surico D, Surico N. Vaginal hysterectomy and multimodal anaesthesia with bipolar vessel sailing (Biclamp® forceps) versus conventional suture technique: quality results’ analysis. Archives of Gynecology and Obstetrics. 2012; 285: 1025–1029.

[27] Samulak D, Wilczak M, Michalska MM, Pięta B. Vaginal hysterectomy with bipolar coagulation forceps (BiClamp) as an alternative to the conventional technique. Archives of Gynecology and Obstetrics. 2011; 284: 145–149.

[28] Richter S, Kollmar O, Schilling MK, Pistorius GA, Menger MD. Efficacy and quality of vessel sealing: comparison of a reusable with a disposable device and effects of clamp surface geometry and structure. Surgical Endoscopy. 2006; 20: 890–894.

[29] Blayney GV, Beirne JP, Hinds L, Quinn D, Dorman GJ. Vaginal hys-terectomy using the ERBE BiClamp® BIPOLAR VESSEL SEALING SYSTEM: A CASE Series. The Ulster Medical Journal. 2017; 86: 167–171.

[30] Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, et al. Risk factors for endometrial cancer: an umbrella review of the literature. International Journal of Cancer. 2019; 145: 1719–1730.

[31] Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecologic Oncology. 2006; 101: 520–529.

[32] Smith SM, Hoffman MS. The role of vaginal hysterectomy in the treatment of endometrial cancer. American Journal of Obstetrics and Gynecology. 2007; 197: 202.e1–202.e7.

[33] Berretta R, Merisio C, Melpignano M, Rolla M, Ceccaroni M, DE Ioris A, et al. Vaginal versus abdominal hysterectomy in endometrial cancer: a retrospective study in a selective population. International Journal of Gynecological Cancer. 2008; 18: 797–802.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time