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A systematic review and network meta-analysis comparing energy devices used in colorectal surgery

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Abstract

Background

The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery.

Methods

A systematic literature review and Bayesian network meta-analysis performed. MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane were searched from inception to August 11th 2021. Intraoperative outcomes were operative blood loss, operative time, conversion to open, conversion to another energy source. Postoperative outcomes were mortality, overall complications, minor complications and major complications, wound complications, postoperative ileus, anastomotic leak, time to first defecation, day 1 and 3 drainage volume, duration of hospital stay.

Results

Seven randomized controlled trials (RCTs) were included, reporting on 680 participants, comparing conventional hemostasis, LigaSure™, Thunderbeat® and Harmonic®. Harmonic® had fewer overall complications compared to conventional hemostasis. Operative blood loss was less with LigaSure™ (mean difference [MD] = 24.1 ml; 95% confidence interval [CI] − 46.54 to − 1.58 ml) or Harmonic® (MD = 24.6 ml; 95% CI − 42.4 to − 6.7 ml) compared to conventional techniques. Conventional hemostasis ranked worst for operative blood loss with high probability (p = 0.98). LigaSure™, Harmonic® or Thunderbeat® resulted in a significantly shorter mean operative time by 42.8 min (95% CI − 53.9 to − 31.5 min), 28.3 min (95% CI − 33.6 to − 22.6 min) and 26.1 min (95% CI − 46 to − 6 min), respectively compared to conventional electrosurgery. LigaSure™ resulted in a significantly shorter mean operative time than Harmonic® by 14.5 min (95% CI 1.9–27 min) and ranked first for operative time with high probability (p = 0.97). LigaSure™ and Harmonic® resulted in a significantly shorter mean duration of hospital stay compared to conventional electrosurgery of 1.3 days (95% CI − 2.2 to − 0.4) and 0.5 days (95% CI − 1 to − 0.1), respectively. LigaSure™ ranked as best for hospital stay with high probability (p = 0.97). Conventional hemostasis was associated with more wound complications than Harmonic® (odds ratio [OR] = 0.27; CI 0.08–0.92). Harmonic® ranked best with highest probability (p = 0.99) for wound complications. No significant differences between energy devices were identified for the remaining outcomes.

Conclusions

LigaSure™, Thunderbeat® and Harmonic® may be advantageous for reducing operative blood loss, operative time, overall complications, wound complications, and duration of hospital stay compared to conventional techniques. The energy devices result in comparable perioperative outcomes and no device is superior overall. However, included RCTs were limited in number and size, and data were not available to compare all energy devices for all outcomes of interest.

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Authors and Affiliations

  1. Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    M. Charalambides, T. Afxentiou, M. P. Powar, N. S. Fearnhead, R. J. Davies, J. Wheeler & C. Simillis

  2. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy

    G. Pellino

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  1. M. Charalambides
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  2. T. Afxentiou
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  3. G. Pellino
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  4. M. P. Powar
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  5. N. S. Fearnhead
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  6. R. J. Davies
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  7. J. Wheeler
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  8. C. Simillis
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Contributions

MC: literature search, acquisition of data, data analysis, interpretation of data, figures, tables, drafting the article. TA: literature search, acquisition of data, data analysis, figures, tables, final approval of the article. GP: interpretation of data, article revision, final approval of the article. MPP: conception and design of the study, interpretation of data, article revision, final approval of the article. NSF: conception and design of the study, interpretation of data, article revision, final approval of the article. RJD: conception and design of the study, interpretation of data, article revision, final approval of the article. JW: conception and design of the study, interpretation of data, article revision, final approval of the article. CS: conception and design of the study, literature search, acquisition of data, data analysis, interpretation of data, figures, tables, drafting the article, final approval of the article.

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Correspondence to C. Simillis.

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Charalambides, M., Afxentiou, T., Pellino, G. et al. A systematic review and network meta-analysis comparing energy devices used in colorectal surgery. Tech Coloproctol 26, 413–423 (2022). https://doi.org/10.1007/s10151-022-02586-0

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