Comparison of perioperative surgical outcomes between a bipolar device and an ultrasonic device during laparoscopic gastrectomy for gastric cancer

Abstract

Background The use of energy devices during laparoscopic gastrectomy for gastric cancer has increased as the frequency of laparoscopic surgery has increased. Our aim was to compare the perioperative surgical outcomes between using a bipolar device and an ultrasonic device during laparoscopic gastrectomy. Methods Retrospective review of a prospectively maintained database identified 186 patients who underwent laparoscopic gastrectomy performed by a single surgeon between November 2010 and August 2013. A bipolar device was used for 116 patients, and an ultrasonic device was used for 70 patients. Patient characteristics and perioperative surgical outcomes were compared between groups. Results Clinicopathologic characteristics were similar for both groups. The bipolar group had a significantly shorter operation time (154.9 vs. 167.8 min, p = 0.028) and higher rate of D2 lymph node dissection (29.3 vs. 15.7 %, p = 0.012). The bipolar device group experienced significantly less pain at 12 h [visual analog scale (VAS) pain score: 3.9 vs. 4.7, p = 0.027) and 18 h (VAS pain score: 3.5 vs. 4.1, p = 0.036) postoperatively. The bipolar group had earlier abdominal drain removal (p = 0.001) and a shorter hospital stay (p = 0.024). No significant differences in laboratory value changes, morbidity, or mortality were observed between the groups. Conclusion Compared with the ultrasonic device, the bipolar device provided advantages in operation time, degree of postoperative pain, time of drain removal, and length of hospital stay. The bipolar device may be a useful and efficient energy device for laparoscopic gastrectomy. However, larger studies to confirm the safety of bipolar device during laparoscopic gastrectomy are warranted. Keywords Laparoscopic gastrectomy Gastric neoplasms Bipolar Ultrasonic Lymph node dissection Hemostasis Laparoscopic surgery has gained wide acceptance because of its minimally invasive nature. As the number of clinical applications for laparoscopic surgery has increased, the number of instruments developed for use during laparoscopic procedures has also expanded. The variety of instruments available for use during laparoscopic gastrectomy for gastric cancer has likewise increased. Instrument options for use during laparoscopic gastrectomy include endo-linear staplers, laparoscopic clips, and vessel sealing devices. Among the vessel sealing devices, bipolar devices and ultrasonic devices are the most widely used energy devices [1–5]. Although these instruments were originally designed for vessel sealing and coagulation, they can also be used for concurrent tissue dissection [3]. Most studies comparing these two devices have been performed in patients who underwent thyroidectomy, hemorrhoidectomy, or laparoscopic colectomy [6–9]. However, to the best of our knowledge, there has been no previous comparison of these two devices during laparoscopic gastrectomy. Furthermore, the use of the bipolar device for laparoscopic gastrectomy has not been heretofore reported. Previous reports of the bipolar device for gastric surgery have involved only comparisons with conventional ligation methods during open gastrectomy [10, 11]. We hypothesized that differences between sealing mechanisms could affect the perioperative surgical outcome. To compare the efficacy and safety of a bipolar device with that of an ultrasonic device during laparoscopic gastrectomy, we retrospectively evaluated and compared patient clinicopathologic characteristics, operative parameters, and short-term surgical outcomes.