Petra F Janssen1, Hans A M Brölmann, Judith A F Huirne. 1. Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1181 HV, Amsterdam, The Netherlands. pfjanssen@hetnet.nl
Abstract
BACKGROUND: Adequate hemostatic techniques are essential for optimal intra- and postoperative results. A number of different hemostatic techniques and devices have been developed over the past few years, but which device should be preferred during laparoscopic and open abdominal procedures? METHODS: We conducted a systematic search for randomized controlled trials (RCTs) that compared the effectiveness and costs of vessel-sealing devices with those of other electrothermal or ultrasonic devices in abdominal surgical procedures. RESULTS: Seven RCTs that included 554 patients met the inclusion criteria. Various procedures that used a vessel-sealing device (LigaSure™) (n = 264) were compared to ultrasonic devices (n = 139) and mono- (n = 20) or bipolar devices (n = 130). LigaSure was favored in two studies with respect to less blood loss, shorter operating time, and lower costs. However, no differences were observed in the other studies. Considering the relatively low number of complications, all hemostatic devices used may be considered relatively safe. None of the studies reported on quality of life or cost effectiveness. CONCLUSIONS: Vessel-sealing devices may be considered safe and their use may reduce costs due to reduced blood loss and shorter operating time in some abdominal surgical procedures compared to mono- or bipolar electrothermal devices. Wider-ranging RCTs of sufficient quality that assess (cost) effectiveness are required to make firm conclusions.
BACKGROUND: Adequate hemostatic techniques are essential for optimal intra- and postoperative results. A number of different hemostatic techniques and devices have been developed over the past few years, but which device should be preferred during laparoscopic and open abdominal procedures? METHODS: We conducted a systematic search for randomized controlled trials (RCTs) that compared the effectiveness and costs of vessel-sealing devices with those of other electrothermal or ultrasonic devices in abdominal surgical procedures. RESULTS: Seven RCTs that included 554 patients met the inclusion criteria. Various procedures that used a vessel-sealing device (LigaSure™) (n = 264) were compared to ultrasonic devices (n = 139) and mono- (n = 20) or bipolar devices (n = 130). LigaSure was favored in two studies with respect to less blood loss, shorter operating time, and lower costs. However, no differences were observed in the other studies. Considering the relatively low number of complications, all hemostatic devices used may be considered relatively safe. None of the studies reported on quality of life or cost effectiveness. CONCLUSIONS: Vessel-sealing devices may be considered safe and their use may reduce costs due to reduced blood loss and shorter operating time in some abdominal surgical procedures compared to mono- or bipolar electrothermal devices. Wider-ranging RCTs of sufficient quality that assess (cost) effectiveness are required to make firm conclusions.
Authors: Jaime Landman; Kurt Kerbl; Jamil Rehman; Cassio Andreoni; Peter A Humphrey; William Collyer; Ephrem Olweny; Chandru Sundaram; Ralph V Clayman Journal: J Urol Date: 2003-02 Impact factor: 7.450
Authors: Petra F Janssen; Hans A M Brölmann; Paul J M van Kesteren; Marlies Y Bongers; Andreas L Thurkow; Martijn W Heymans; Judith A F Huirne Journal: Surg Endosc Date: 2012-04-27 Impact factor: 4.584
Authors: Eduardo Ma Targarona; Carmen Balague; Juan Marin; Rene Berindoague Neto; Carmen Martinez; Jordi Garriga; Manuel Trias Journal: Surg Innov Date: 2005-12 Impact factor: 2.058
Authors: P F Janssen; H A M Brölmann; P J M van Kesteren; M Y Bongers; A L Thurkow; M W Heymans; J A F Huirne Journal: BJOG Date: 2011-09-06 Impact factor: 6.531
Authors: Oliver S Eng; Julie Goswami; Dirk Moore; Chunxia Chen; Jennifer Brumbaugh; Christopher J Gannon; David A August; Darren R Carpizo Journal: HPB (Oxford) Date: 2013-06-19 Impact factor: 3.647
Authors: Tobias Gehrig; A T Billeter; A L Wekerle; M Shevchenko; K Brand; B P Müller-Stich Journal: Langenbecks Arch Surg Date: 2016-03-23 Impact factor: 3.445