Vascular pedicle ligation techniques during laparoscopic colectomy. A prospective randomized trial

Area of Science:

• Surgical Technology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic colectomy utilizes various devices for pedicle ligation, including vascular staplers, clips, and electrothermal bipolar vessel-sealing devices.
• Choosing the appropriate device is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To compare the speed, reliability, and cost-effectiveness of different devices for intracorporeal pedicle ligation during laparoscopic colectomy.
• To guide surgeons in selecting the optimal device for pedicle ligation.

Main Methods:

• A prospective randomized study compared laparoscopic vascular staplers and disposable clip appliers (S/C) against the LigaSure Atlas (LIG).
• The study included elective right, left, and total colectomies, with cases stratified by procedure.
• Device failure was defined as any bleeding post-ligation.

Main Results:

• No significant differences in demographics, diagnosis, procedure, number of vessels ligated, or operative time were observed between the S/C and LIG groups.
• Device failure occurred in 9.2% of vessels ligated with S/C devices versus 3% with the LIG device (p=0.02).
• The LigaSure Atlas demonstrated significantly lower mean cost per case ($317 vs. $400, p<0.001), particularly for total colectomy.

Conclusions:

• While stapler/clip devices showed higher failure rates, neither device type resulted in significant blood loss.
• The LigaSure Atlas is a more cost-effective option for laparoscopic colectomy, offering potential versatility.
• Cost savings were most pronounced in total colectomy procedures.