Abstract：
Although EBDs are essential for minimally invasive surgery, well-established prospective randomized studies comparing EBDs are scarce. This study aimed to compare the intraoperative inflammatory response and short-term surgical outcomes among different energy-based devices (EBDs) in laparoscopic distal gastrectomy (LDG).
Patients with clinical stage I gastric cancer scheduled for LDG at two different medical centers were prospectively randomized into three groups: ultrasonic shears (US), advanced bipolar (BP) and ultrasonic-bipolar hybrid (HB). The C-reactive protein (CRP) level, operation time, intraoperative blood loss (IBL), laboratory tests, cytokines (interleukin (IL)-6 and IL-10), hospital stay, and complication rate were analyzed. A novel semiquantitative measurement method using indocyanine green (ICG) and a near-infrared camera measured the amount of lymphatic leakage.
The primary endpoint, the CRP level, was significantly lower in the BP (n = 60) group than in the US (n = 57) or HB (n = 57) group [9.03 ± 5.55 vs. 11.12 ± 5.02 vs. 12.67 ± 6.14, p = 0.001, on postoperative day (POD) 2 and 7.48 vs. 9.62 vs. 9.48, p = 0.026, on POD 4]. IBL was significantly lower in BP than in US or HB (26.3 ± 25.3 vs. 43.7 ± 42.0 vs. 34.9 ± 37.0, p = 0.032). Jackson-Pratt drainage triglycerides were significantly lower in BP than in US (53.6 ± 33.7 vs. 84.2 ± 59.0, p = 0.11; HB: 71.3 ± 51.4). ICG fluorescence intensity, operation time, laboratory results, cytokines, hospital stay, and complication rate were not significantly different among the 3 groups.
BP showed a lower postoperative CRP level and less IBL than US and HB, suggesting less collateral thermal damage and better sealing function. Surgeons may consider this when selecting EBDs for laparoscopic surgery.
Patients with clinical stage I gastric cancer scheduled for LDG at two different medical centers were prospectively randomized into three groups: ultrasonic shears (US), advanced bipolar (BP) and ultrasonic-bipolar hybrid (HB). The C-reactive protein (CRP) level, operation time, intraoperative blood loss (IBL), laboratory tests, cytokines (interleukin (IL)-6 and IL-10), hospital stay, and complication rate were analyzed. A novel semiquantitative measurement method using indocyanine green (ICG) and a near-infrared camera measured the amount of lymphatic leakage.
The primary endpoint, the CRP level, was significantly lower in the BP (n = 60) group than in the US (n = 57) or HB (n = 57) group [9.03 ± 5.55 vs. 11.12 ± 5.02 vs. 12.67 ± 6.14, p = 0.001, on postoperative day (POD) 2 and 7.48 vs. 9.62 vs. 9.48, p = 0.026, on POD 4]. IBL was significantly lower in BP than in US or HB (26.3 ± 25.3 vs. 43.7 ± 42.0 vs. 34.9 ± 37.0, p = 0.032). Jackson-Pratt drainage triglycerides were significantly lower in BP than in US (53.6 ± 33.7 vs. 84.2 ± 59.0, p = 0.11; HB: 71.3 ± 51.4). ICG fluorescence intensity, operation time, laboratory results, cytokines, hospital stay, and complication rate were not significantly different among the 3 groups.
BP showed a lower postoperative CRP level and less IBL than US and HB, suggesting less collateral thermal damage and better sealing function. Surgeons may consider this when selecting EBDs for laparoscopic surgery.
摘要：
背景：尽管EBD对于微创手术至关重要，比较EBD的完善的前瞻性随机研究很少.本研究旨在比较腹腔镜远端胃切除术（LDG）中不同能量器械（EBD）的术中炎症反应和短期手术结果。
方法：将在两个不同的医疗中心进行LDG的临床I期胃癌患者随机分为三组：超声剪（US），先进的双极（BP）和超声-双极混合（HB）。C反应蛋白(CRP)水平,操作时间,术中失血（IBL），实验室测试,细胞因子（白细胞介素（IL）-6和IL-10），住院,并对并发症发生率进行分析。使用吲哚菁绿（ICG）和近红外相机的新型半定量测量方法测量了淋巴渗漏的量。
结果：主要终点，CRP水平,BP（n=60）组明显低于美国（n=57）或HB（n=57）组[9.03±5.55vs.11.12±5.02vs.12.67±6.14，p=0.001，术后第2天（POD）和7.48天9.62vs.9.48，p=0.026，关于POD4]。BP的IBL显着低于US或HB（26.3±25.3vs.43.7±42.0vs.34.9±37.0，p=0.032）。Jackson-Pratt引流甘油三酯在BP中明显低于美国（53.6±33.7vs.84.2±59.0，p=0.11；HB：71.3±51.4）。ICG荧光强度,操作时间,实验室结果,细胞因子,住院,3组之间并发症发生率差异无统计学意义。
结论：BP显示术后CRP水平低于US和HB，IBL较低，表明较少的附带热损伤和更好的密封功能。外科医生在选择腹腔镜手术的EBD时可能会考虑这一点。
方法：将在两个不同的医疗中心进行LDG的临床I期胃癌患者随机分为三组：超声剪（US），先进的双极（BP）和超声-双极混合（HB）。C反应蛋白(CRP)水平,操作时间,术中失血（IBL），实验室测试,细胞因子（白细胞介素（IL）-6和IL-10），住院,并对并发症发生率进行分析。使用吲哚菁绿（ICG）和近红外相机的新型半定量测量方法测量了淋巴渗漏的量。
结果：主要终点，CRP水平,BP（n=60）组明显低于美国（n=57）或HB（n=57）组[9.03±5.55vs.11.12±5.02vs.12.67±6.14，p=0.001，术后第2天（POD）和7.48天9.62vs.9.48，p=0.026，关于POD4]。BP的IBL显着低于US或HB（26.3±25.3vs.43.7±42.0vs.34.9±37.0，p=0.032）。Jackson-Pratt引流甘油三酯在BP中明显低于美国（53.6±33.7vs.84.2±59.0，p=0.11；HB：71.3±51.4）。ICG荧光强度,操作时间,实验室结果,细胞因子,住院,3组之间并发症发生率差异无统计学意义。
结论：BP显示术后CRP水平低于US和HB，IBL较低，表明较少的附带热损伤和更好的密封功能。外科医生在选择腹腔镜手术的EBD时可能会考虑这一点。
