关键词: Colorectal surgery Energy devices Harmonic Ligasure Network meta-analysis Operative outcomes Systematic review Thunderbeat

Mesh : Blood Loss, Surgical Colorectal Surgery / adverse effects Humans Length of Stay Network Meta-Analysis Operative Time Postoperative Complications / etiology

来  源:   DOI:10.1007/s10151-022-02586-0

Abstract:
The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery.
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.
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.
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.
摘要:
这项研究的目的是比较在结直肠手术中用于术中止血的能量装置。
进行了系统的文献综述和贝叶斯网络荟萃分析。MEDLINE,EMBASE,科学引文索引扩展,和Cochrane从成立到2021年8月11日进行了搜索。术中结果为手术失血,手术时间,转换为开放,转换为另一种能源。术后结果是死亡率,整体并发症,轻微并发症和主要并发症,伤口并发症,术后肠梗阻,吻合口漏,第一次排便的时间,第1天和第3天的排水量,住院时间。
共纳入7项随机对照试验(RCT),报告680名参与者,比较常规止血,LigaSure™,Thunderbeat®和谐波®。与常规止血相比,谐波®的总体并发症较少。与传统技术相比,LigaSure™(平均差[MD]=24.1ml;95%置信区间[CI]-46.54至-1.58ml)或Harmonic®(MD=24.6ml;95%CI-42.4至-6.7ml)的手术失血更少。常规止血在手术失血中排名最差,可能性很高(p=0.98)。LigaSure™,Harmonic®或Thunderbeat®导致平均手术时间显著缩短42.8分钟(95%CI-53.9至-31.5分钟),28.3分钟(95%CI-33.6至-22.6分钟)和26.1分钟(95%CI-46至-6分钟),分别与传统的电外科进行比较。LigaSure™的平均手术时间比Harmonic®显著缩短了14.5分钟(95%CI1.9-27分钟),并且在手术时间上排名第一(p=0.97)。与传统电手术相比,LigaSure™和Harmonic®的平均住院时间明显缩短,为1.3天(95%CI-2.2至-0.4)和0.5天(95%CI-1至-0.1)。分别。LigaSure™在住院期间被评为最佳,概率高(p=0.97)。与Harmonic®相比,常规止血与更多的伤口并发症相关(比值比[OR]=0.27;CI0.08-0.92)。对于伤口并发症,谐波®以最高概率(p=0.99)排名最佳。对于其余结果,未发现能量设备之间的显着差异。
LigaSure™,Thunderbeat®和Harmonic®可能有利于减少手术失血,手术时间,整体并发症,伤口并发症,与传统技术相比,住院时间。能量装置可产生相当的围手术期结果,并且没有装置整体上更优越。然而,包括RCT的数量和大小有限,并且没有数据可用于比较所有能量设备的所有目标结局.
公众号