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Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection

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Energy source instruments for laparoscopic colectomy.

Samson Tou¹, Ali Irqam Malik, Steven D Wexner

¹Department of Colorectal Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville West, Adelaide, South Australia, Australia, 5011.

The Cochrane Database of Systematic Reviews

|May 13, 2011

Summary

This summary is machine-generated.

Ultrasonic coagulating shears (UCS) and electrothermal bipolar vessel sealers (EBVS) offer better hemostatic control during laparoscopic colectomy compared to monopolar electrocautery scissors (MES). However, current evidence is limited, preventing a definitive conclusion on the best instrument.

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Area of Science:

Minimally Invasive Surgery
Surgical Oncology
Gastrointestinal Surgery

Background:

Laparoscopic colectomy is increasingly performed for benign and malignant conditions.
Key instruments include monopolar electrocautery scissors (MES), ultrasonic coagulating shears (UCS), and electrothermal bipolar vessel sealers (EBVS).

Purpose of the Study:

To assess the safety and effectiveness of MES, UCS, and EBVS in laparoscopic colectomy.

Main Methods:

Systematic review of randomized controlled trials identified via major databases (PubMed, EMBASE, Cochrane).
Included patients undergoing elective laparoscopic colectomy for benign or malignant conditions.
Primary outcomes: blood loss, complications, and operating time.

Main Results:

UCS showed significantly less blood loss than MES.
EBVS use resulted in shorter operating times compared to MES.
UCS and EBVS demonstrated superior hemostatic control over MES.
Limited data prevented definitive conclusions on complications or cost-effectiveness.

Conclusions:

The current evidence base is limited by small trial numbers and heterogeneity.
It is not possible to definitively identify the optimal instrument for laparoscopic colectomy.
Further research is needed to provide more informative comparisons.