Comparison of Contemporary Energy-Based Surgical Vessel Sealing Devices in Laparoscopic Sleeve Gastrectomy

Abstract

Introduction

The last few decades have witnessed exceptional growth in surgical innovation leading to the evolution of conventional gastro-intestinal surgery, and the birth of minimally invasive surgery.

Aim

A prospective longitudinal study was conducted to compare the safety, efficacy, and cost of three commonly used energy-based surgical vessel sealing devices in patients undergoing laparoscopic sleeve gastrectomy.

Material and Methods

254 consecutive patients who underwent laparoscopic sleeve gastrectomy to treat obesity were included in the study. Time to clear the greater curvature of the stomach, total operative time, intra-operative complications including bleeding, length of hospital stay, 30-day postoperative complications, and overall procedure costs were compared according to the energy device used.

Results

Clearing the greater curvature of the stomach using Harmonic® was the fastest, taking only 13.6 minutes.  However, there was no statistically significant difference in overall procedure duration or length of hospital stay for the three devices. No deaths occurred in this study. The quantity of intra-operative blood loss was least in the LigaSure™ group (45.6 ml). There was no statistically significant difference in the number of patients who had Intra-operative complications or those who had 30-day postoperative complications.

Conclusion

All devices were safe and effective energy devices when used in laparoscopic sleeve gastrectomy allowing for operative time reduction with minimal blood loss. The device type had no effect on the development of intra-operative or postoperative complications. The device type also had no impact on the overall procedure cost. Therefore, the device selection should depend on the surgeon's personal preference and local hospital resources.