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

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 26; no. 3; pp. 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: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-05-2023; Springer Nature B.V
• 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; United States > US; Energy devices; Laparoscopy gastrectomy; Bipolar; Early gastric cancer; Ultrasonic
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-023-01365-6

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.