Energy Sources for Laparoscopic Colorectal Surgery: Is One Better than the Others?

Allaix, Marco Ettore; Furnée, Edgar J.B.; Arezzo, Alberto; Mistrangelo, Massimiliano; Morino, Mario

doi:10.1089/lap.2016.0076

Cited by 16 publications

(13 citation statements)

References 24 publications

(34 reference statements)

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“…Figure 1 shows the process of study selection and reasons for exclusions. The SRs were published between 2011 to 2016 and included participants diagnosed with breast cancer (3 SRs) [ 13 , 21 , 22 ], gastric cancers (3 SRs) [ 12 , 23 , 24 ], oral, head, and neck cancers (1 SR) [ 14 ], and colon cancers (3 SRs) [ 28 – 30 ]. None of the included SRs assessed quality of evidence (certainty in evidence) using GRADE.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of included SRs in this category varied considerably with two lower quality SRs [ 28 , 29 ] and one higher quality Cochrane Review [ 30 ] according to AMSTAR (Table 2 ). Included trials in these SRs were comprised of a mixed population of patients with benign and malignant colon diseases (including diverticulitis, polyps, colorectal adenoma and adenocarcinoma, and epidermoid carcinoma).…”

Section: Resultsmentioning

confidence: 99%

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Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

Cheng¹,

Clymer²,

Sadeghirad³

et al. 2018

World J Surg Onc

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BackgroundWe performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology (including lymph node dissection).MethodsWe searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception to end of March of 2017 for meta-analyses or systematic reviews of randomized trials comparing HS to conventional techniques in surgical oncology. We assessed the quality of included systematic reviews with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and assessed the certainty in evidence for each pooled outcome using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).ResultsWe identified ten systematic reviews on breast cancer (n = 3), gastric cancers (n = 3), oral, head, and neck cancers (n = 1), and colon cancers (n = 3). Most reviews received a higher rating using AMSTAR. For operative time, systematic reviews reported a reduction of 25 to 29 min for HS compared with conventional methods across oncology types, with the exception of breast cancer where little differences were observed (very low to moderate quality of evidence (GRADE)). For blood loss and drainage volume, the majority of reviews reported statistically significant reductions with HS, and reductions ranged from 42 to 141 mL, and from 42 to 292 mL, respectively (very low to moderate quality of evidence). Hospitalization days were reported to decrease with use of HS by 0.2 to 3.2 days; however, reductions were only statistically significant for half of the included reviews (low to moderate quality of evidence). Regarding perioperative complications, two of six reviews reported a significantly reduced risk with HS use (breast cancer surgery) (moderate to high quality evidence)).ConclusionAcross surgical oncology types, the majority of included systematic reviews showed a statistically significant or numerical improvement in surgical outcomes with use of the HS compared with conventional methods. Well-designed randomized studies with large sample sizes will help to provide more precise estimates and reduce the risk of heterogeneity.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1298-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

Cheng¹,

Clymer²,

Sadeghirad³

et al. 2018

World J Surg Onc

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“…However, the device prices may differ between different institutions. Allaix et al also did not find any cost difference between TB and other energy devices [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bipolar electrosurgical technology has been widely used in laparoscopic bowel resection and considered a safe method for dissection and vessel ligation [1,[8][9][10]. Recent studies comparing TB to other energy devices suggest that all are safe and effective to use in laparoscopic colorectal surgery and report similar intraoperative and postoperative outcomes [2,11,12]. However, most of these studies are retrospective cohort studies or small prospective cohorts.…”

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confidence: 99%

A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

et al. 2021

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Background The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. Methods Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. Results 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. Conclusions Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. ClinicalTrial.gov # NCT02628093.

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“…Today the choice among the HED is mainly based on the surgeon's preference. In fact, only a few studies that compare the different technologies have been published to date [8][9][10] without finding a clear advantage for the use of US or RF. There is also a lack of multidimensional evaluation of available instruments.…”

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confidence: 99%

Current status on the adoption of high energy devices in Italy: An Italian Society for Endoscopic Surgery and New Technologies (SICE) national survey

et al. 2020

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Background In the past three decades, different High Energy Devices (HED) have been introduced in surgical practice to improve the efficiency of surgical procedures. HED allow vessel sealing, coagulation and transection as well as an efficient tissue dissection. This survey was designed to verify the current status on the adoption of HED in Italy. Methods A survey was conducted across Italian general surgery units. The questionnaire was composed of three sections (general information, elective surgery, emergency surgery) including 44 questions. Only one member per each surgery unit was allowed to complete the questionnaire. For elective procedures, the survey included questions on thyroid surgery, lower and upper GI surgery, proctologic surgery, adrenal gland surgery, pancreatic and hepatobiliary surgery, cholecystectomy, abdominal wall surgery and breast surgery. Appendectomy, cholecystectomy for acute cholecystitis and bowel obstruction due to adhesions were considered for emergency surgery. The list of alternatives for every single question included a percentage category as follows: " < 25%, 25-50%, 51-75% or > 75%", both for open and minimally-invasive surgery. Results A total of 113 surgical units completed the questionnaire. The reported use of HED was high both in open and minimally-invasive upper and lower GI surgery. Similarly, HED were widely used in minimally-invasive pancreatic and adrenal surgery. The use of HED was wider in minimally-invasive hepatic and biliary tree surgery compared to open surgery, whereas the majority of the respondents reported the use of any type of HED in less than 25% of elective cholecystectomies. HED were only rarely employed also in the majority of emergency open and laparoscopic procedures, including cholecystectomy, appendectomy, and adhesiolysis. Similarly, very few respondents declared to use HED in abdominal wall surgery and proctology. The distribution of the most used type of HED varied among the different surgical interventions. US HED were mostly used in thyroid, upper GI, and adrenal surgery. A relevant use of H-US/RF devices was reported in lower GI, pancreatic, hepatobiliary and breast surgery. RF HED were the preferred choice in proctology. Conclusion HED are extensively used in minimally-invasive elective surgery involving the upper and lower GI tract, liver, pancreas and adrenal gland. Nowadays, reasons for choosing a specific HED in clinical practice rely on several aspects, including surgeon's preference, economic features, and specific drawbacks of the energy employed.

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Energy Sources for Laparoscopic Colorectal Surgery: Is One Better than the Others?

Cited by 16 publications

References 24 publications

Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

Current status on the adoption of high energy devices in Italy: An Italian Society for Endoscopic Surgery and New Technologies (SICE) national survey

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