Can Energy Devices Replace Clips and Sutures in Laparoscopic Appendectomies: A Systematic Review

There are multiple techniques for closure of the appendiceal stump during laparoscopic appendectomy. There is an increasing body of literature demonstrating the safety of both the LigaSure (Medtronic) and the Harmonic Scalpel (Ethicon, Johnson & Johnson) for sealing the appendiceal base. The goal of this study was to systematically review the current literature supporting appendectomies with base closure performed using energy devices.

PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were queried for human studies where the appendiceal base was sealed with the LigaSure or Harmonic Scalpel. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines were followed.

A total of 65 studies were identified, 26 duplicates were removed, 39 abstracts were screened, 15 irrelevant abstracts were excluded, and seven studies were excluded during full-text review, yielding a total of seven included studies: 3 single-arm (1-retrospective, 1-prospective, and 1-cross-sectional) 1 comparative retrospective and prospective study, 1 comparative prospective study, and two comparative retrospective studies. Across studies, the technique used to seal the appendiceal base was as follows: sutures (n = 141), clips (n = 245), Harmonic Scalpel (n = 308), LigaSure (n = 385). There were no increased postoperative complications in appendectomies performed with energy devices. Appendectomies performed with energy device base closure consistently led to decreased operative times compared to appendectomies performed without energy device base closure.

The available limited literature supports the potential use of the Harmonic and LigaSure to seal the appendiceal base with decreased operative times. Prospective studies are warranted.