GPPO17: Comparison of perioperative outcomes between bipolar sealing, ultrasonic shears and hybrid device during laparoscopic gastrectomy for early gastric cancer: A prospective, multi-center, randomized study
Clinical assistant professor Gachon University Gil Medical Center Incheon, Republic of Korea
Background: Although EBDs are essential to enable 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 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 in laparoscopic surgery.