Operative Time and Other Outcomes of the Electrothermal Bipolar Vessel Sealing System (LigaSure™) Versus Other Methods for Surgical Hemostasis: A Meta-Analysis

Abstract

A meta-analysis was performed of 29 prospective, randomized trials (published January 1, 2000, to August 14, 2007) comparing an electrothermal bipolar vessel sealing system (EBVS-LigaSure™, Covidien) (total n = 1107 patients) with either clamping with suture ligation/ electrocauterization (n = 1079 patients) or ultrasonic energy (eg, Harmonic Scalpel®, Johnson & Johnson). Hemorrhoidectomy (12 articles), hysterectomy (4 articles), and thyroidectomy (3 articles) were the most common procedures. For 15 of 26 studies reporting standard deviations, the normalized mean operative time reduction for EBVS equaled 28% (95% confidence interval [CI] 18%-39%, P < .0001) compared with conventional surgical hemostasis. Operative time was reduced with EBVS in 24 of 26 studies (P < .0001). EBVS was associated with 43 mL (95% CI 14-73 mL, P = .0021) less blood loss, fewer complications (odds ratio 0.66, 95% CI 0.47-0.92, P = .02), and mean reduction in postoperative pain of 2.8 units (95% CI 1.5-4.1, P < .0001). Five studies used ultrasonic energy as the comparator, but none reported standard deviation so data could not be pooled.

Keywords

operative time surgical hemostasis blood loss pain scores complications electrothermal bipolar vessel sealing system

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References

Carbonell AM , Joels CS , Kercher KW , Matthews BD , Sing RF , Heniford BT A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries . J Laparoendosc Adv Surg Tech A. 2003;13:377-380.

Kennedy JS , Stranahan PL , Taylor KD , Chandler JG High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc. 1998;12:876-878.

Harold KL , Pollinger H. , Matthews BD , Kercher KW , Sing RF , Heniford BT Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc. 2003;17:1228-1230.

Mulrow CD , Cook DJ , eds. Systematic Reviews: Synthesis of Best Evidence for Health Care Decisions. Philadelphia, Pa: American College of Physicians; 1998.

Choi P. , Halpern S. , Malik N. , et al. Examining the evidence in anesthesia literature: a critical appraisal of systematic reviews. Anesth Analg. 2001;92:700-709.

Cook DJ , Sackett DL , Spitzer WO Methodological guidelines for systematic reviews of randomized control trials in healthcare from the Potsdam consultation on meta-analysis. J Clin Epidemiol. 1995;48:167-171.

van Tulder MW , Assendelft WJ , Koes BW , Bouter LM Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine. 1997;22:2323-2330.

Matthews BD , Pratt BL , Backus CL , et al. Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg. 2001;67:901-906.

Prokopakis EP , Lachanas VA , Benakis AA , Helidonis ES , Velegrakis GA Tonsillectomy using the Ligasure vessel sealing system: a preliminary report. Int J Pediatr Otorhinolaryngol . 2005;69:1183-1186.

10.

Takada M. , Ichihara T. , Kuroda Y. Comparative study of electrothermal bipolar vessel sealer and ultrasonic coagulating shears in laparoscopic colectomy. Surg Endosc . 2005;19:226-228.

11.

Sengupta S. , Webb DR Use of a computer-controlled bipolar diathermy system in radical prostatectomies and other open urological surgery. ANZ J Surg. 2001;71:538-540.

12.

Manasia P. , Alcaraz A. , Alcover J. Ligasure versus sutures in bladder replacement with Montie ileal neobladder after radical cystectomy. Arch Ital Urol Androl. 2003;75:199-201.

13.

Wang JY , Tsai HL , Chen FM , et al. Prospective, randomized, controlled trial of Starion vs Ligasure hemorrhoidectomy for prolapsed hemorrhoids. Dis Colon Rectum . 2007;50:1146-1151.

14.

Wachtel RE , Dexter F. Simple method for deciding what time patients should be ready on the day of surgery without procedure-specific data. Anesth Analg . 2007;105:127-140.

15.

Dexter F. , Ledolter J. Bayesian prediction bounds and comparisons of operating room times even for procedures with few or no historical data. Anesthesiology . 2005;103:1259-1267.

16.

Bushman, BJ Vote-counting procedures in meta-analysis. In: Cooper H , Hodges LV , eds. The Handbook of Research Synthesis. New York, NY: Russell Sage Foundation; 1994 :193-213.

17.

Hartling L. , McAlister FA , Rowe BH , Ezekowitz J. , Friesen C. , Klassen TP Challenges in systematic reviews of therapeutic devices and procedures. Ann Intern Med. 2005 ;142(12 pt 2):1100-1111.

18.

Macario A. , Vitez T. , Dunn B. , McDonald T. What does perioperative care really cost? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83:1138-1144.

19.

Lee JS , Hobden E. , Stiell IG , Wells GA Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10:1128-1130.

20.

Grilo RM , Treves R. , Preux PM , Vergne-Salle P. , Bertin P. Clinically relevant VAS pain score change in patients with acute rheumatic conditions. Joint Bone Spine. 2007;74:358-361.

21.

Jadad AR , Moore A. , Carroll D. , et al. Assessing the quality of reports of randomised clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1-12.

22.

Macario A. , Brock-Utne J. Anesthesiologists overestimate blood loss on both dry and wet surgical gauze sponges. Can J Anesth. 1994;41:1017-1018.