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Ortenzi M, Agresta F, Vettoretto N, Gerardi C, Allocati E, Botteri E, Montori G, Balla A, Arezzo A, Piatto G, Sartori A, Antoniou S, Podda M. Use of High Energy Devices (HEDs) versus electrocautery for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Surg Endosc 2023:10.1007/s00464-023-10060-7. [PMID: 37074420 DOI: 10.1007/s00464-023-10060-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION According to the literature, there is no clear definition of a High Energy Devices (HEDs), and their proper indications for use are also unclear. Nevertheless, the flourishing market of HEDs could make their choice in daily clinical practice arduous, possibly increasing the risk of improper use for a lack of specific training. At the same time, the diffusion of HEDs impacts the economic asset of the healthcare systems. This study aims to assess the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). MATERIALS AND METHODS On behalf of the Italian Society of Endoscopic Surgery and New Technologies, experts performed a systematic review and meta-analysis and synthesised the evidence assessing the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). Only randomised controlled trials (RCTs) and comparative observational studies were included. Outcomes were: operating time, bleeding, intra-operative and post-operative complications, length of hospital stay, costs, and exposition to surgical smoke. The review was registered on PROSPERO (CRD42021250447). RESULTS Twenty-six studies were included: 21 RCTs, one prospective parallel arm comparative non-RCT, and one retrospective cohort study, while three were prospective comparative studies. Most of the studies included laparoscopic cholecystectomy performed in an elective setting. All the studies but three analysed the outcomes deriving from the utilisation of US sources of energy compared to electrocautery. Operative time was significantly shorter in the HED group compared to the electrocautery group (15 studies, 1938 patients; SMD - 1.33; 95% CI - 1.89 to 0.78; I2 = 97%, Random-effect). No other statistically significant differences were found in the other examined variables. CONCLUSIONS HEDs seem to have a superiority over Electrocautery while performing LC in terms of operative time, while no difference was observed in terms of length of hospitalisation and blood loss. No concerns about safety were raised.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
| | - Ferdinando Agresta
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Nereo Vettoretto
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eleonora Allocati
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Andrea Balla
- General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giacomo Piatto
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Stavros Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
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