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A Comparative Study of an Integrated Ultrasonic/Bipolar Sealing Device Versus an Articulating Bipolar Sealing Device for Laparoscopic Liver Surgery

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Abstract

Background

Sealing devices (SD) seal and cut tissue through different energy modalities, and are routinely used in laparoscopic liver surgery (LLS). The aim of this study is to compare the outcome of Thunderbeat (TB), an integrated ultrasonic/bipolar SD, versus Enseal (ES), an articulating bipolar SD, in LLS.

Methods

A retrospective analysis was conducted in a single center from December 2013 to September 2020. The primary endpoint was difference in blood loss (BL) between ES and TB. Secondary endpoints were complications, operative time, hospital stay, and 90-day mortality.

Results

352 patients were identified: TB (n = 105) and ES (n = 247). Median BL was significantly lower with TB (50 mL [20–120]) compared to ES (100 mL [50–250]) (p < 0.0001). Significant differences were identified for median operative time (TB 115 min [45–300]) vs. ES 140 min [40–370]; p = 0.0008) and median hospital stay (TB 2 days [1–4] vs. ES 4 days [3–6]; p < 0.0001). No major differences were encountered for postoperative bleeding (TB 0% vs. ES 1%; p = 0.5574), biliary leak (TB 1% vs. ES 2%; p = 1.0000), and 90-day mortality (TB 0% vs. ES 1%; p = 1.0000).

Conclusion

The integrated ultrasonic/bipolar SD is superior to the articulating bipolar SD in LLS for intraoperative BL without an increase in complications.

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Abbreviations

AHT:

Arterial hypertension

BL:

Blood loss

COPD:

Chronic obstructive pulmonary disease

CRLM:

Colorectal liver metastasis

CUSA:

Cavitron ultrasonic surgical aspirator

CVP:

Central venous pressure

DM:

Diabetes mellitus

ERAS:

Enhanced recovery after surgery

ES:

Enseal device

HCC:

Hepatocellular carcinoma

LLS:

Laparoscopic liver surgery

LLR:

Laparoscopic liver resection

MWA:

Microwave ablation

RFA:

Radiofrequency ablation

SD:

Sealing device

TB:

Thunderbeat device

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Funding

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Author notes

  1. An-Lies Provoost and Mathieu D’Hondt have shared first authorship.

Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    An-Lies Provoost, Mathieu D’Hondt, Celine De Meyere & Anne Devooght

  2. Department of Digestive and Hepatobiliary/Pancreatic Surgery, UZ Leuven, Louvain, Belgium

    Edward Willems

  3. Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium

    Isabelle Parmentier

  4. Interdisciplinary Research Centre, KU Leuven Campus Kulak, Kortrijk, Belgium

    Hans Pottel

  5. Department of Gastroenterology and Hepatology, UZ Leuven, Louvain, Belgium

    Chris Verslype

Authors
  1. An-Lies Provoost
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  2. Mathieu D’Hondt
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  4. Celine De Meyere
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  5. Isabelle Parmentier
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Contributions

A-LP: Conceptualization; data curation; formal analysis; methodology; resources; software; validation; visualization; roles/writing—original draft; writing—review and editing. MD'H: conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; software; supervision; validation; visualization; writing—review and editing. EW: writing—review and editing. CDM: data curation; formal analysis; investigation. IP: data curation; formal analysis; investigation. AD: review and editing. HP: investigation; formal analysis; methodology; resources; software; visualization. CV: investigation; methodology; project administration; resources; supervision; validation; writing—review and editing.

Corresponding author

Correspondence to Mathieu D’Hondt.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics committee of Groeninge Hospital (B3962020000058). This article was written in accordance with the ethical standards of the institutional review board and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all human subjects as is the standard of care and as with compliance with institution guidelines.

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Provoost, AL., D’Hondt, M., Willems, E. et al. A Comparative Study of an Integrated Ultrasonic/Bipolar Sealing Device Versus an Articulating Bipolar Sealing Device for Laparoscopic Liver Surgery. World J Surg 46, 2963–2972 (2022). https://doi.org/10.1007/s00268-022-06734-3

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