Comparison of perioperative outcomes between bipolar sealing, ultrasonic shears and a hybrid device during laparoscopic gastrectomy for early gastric cancer: a prospective, multicenter, randomized study

Background 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 lapar...

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Published in:Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2023-05, Vol.26 (3), p.438-450
Main Authors: Park, Ji-Hyeon, Kong, Seong-Ho, Berlth, Felix, Choi, Jong-Ho, Kim, Sara, Kim, Sa-Hong, Kang, So Hyun, Lee, Sangjun, Yoo, Jaeun, Goo, Eunhee, Jeong, Kyoungyun, Kim, Hyun Myong, Park, Young Suk, Ahn, Sang-Hoon, Suh, Yun-Suhk, Park, Do Joong, Lee, Hyuk-Joon, Kim, Hyung-Ho, Yang, Han-Kwang
Format: Article
Language:English
Subjects:
Abdominal Surgery
C-reactive protein
Cancer Research
Cytokines
Gastrectomy
Gastrectomy - methods
Gastric cancer
Gastroenterology
Gastrointestinal surgery
Humans
Indocyanine Green
Inflammation
Interleukin 10
Laboratories
Laparoscopy
Laparoscopy - methods
Medicine
Medicine & Public Health
Oncology
Original Article
Prospective Studies
Retrospective Studies
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Surgical outcomes
Treatment Outcome
Triglycerides
Ultrasonics
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Summary:Background 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). Methods 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. Results 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. Conclusion 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.
ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-023-01365-6