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

• Published in: Techniques in coloproctology 2022-06, Vol.26 (6), p.413-423
• Main Authors: Charalambides, M., Afxentiou, T., Pellino, G., Powar, M. P., Fearnhead, N. S., Davies, R. J., Wheeler, J., Simillis, C.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Blood Loss, Surgical; Colorectal Surgery; Colorectal Surgery - adverse effects; Gastroenterology; Humans; Length of Stay; Medicine; Medicine & Public Health; Network Meta-Analysis; Operative Time; Postoperative Complications - etiology; Proctology; Review; Surgery
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-022-02586-0

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 du