Hubner M, Demartines N, Muller S, Dindo D, Clavien P-A, Hahnloser D
Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Br J Surg. 2008 Sep;95(9):1098-104. doi: 10.1002/bjs.6321.
Many instruments are used for laparoscopic dissection, including monopolar electrosurgery scissors (MES), electrothermal bipolar vessel sealers (BVS) and ultrasonically coagulating shears (UCS). These three devices were compared with regard to dissection time, blood loss, safety and costs.
Sixty-one consecutive patients undergoing laparoscopic left-sided colectomy were randomized to MES, BVS or UCS. The primary endpoint was dissection time.
Patient and operation characteristics did not differ between the groups. Median dissection time was significantly shorter with BVS (105 min) and UCS (90 min) than with MES (137 min) (P < 0.001). With BVS and UCS, significantly fewer additional clips were required (MES 9 versus BVS 0 versus UCS 3; P < 0.001) and there was a trend towards lower blood loss (125 versus 50 versus 50 ml respectively; P = 0.223) and a reduced volume of suction fluid (425 versus 80 versus 110 ml; P = 0.058). Overall satisfaction was similar for the three instruments. Dissection with BVS and UCS was significantly cheaper than with MES, assuming a centre volume of 200 cases per year (P = 0.009).
BVS and UCS shorten dissection time in laparoscopic left-sided colectomy and are cost-effective compared with MES.
许多器械用于腹腔镜解剖，包括单极电外科剪刀（MES）、电热双极血管闭合器（BVS）和超声凝固剪（UCS）。对这三种器械在解剖时间、失血情况、安全性和成本方面进行了比较。
连续61例行腹腔镜左半结肠切除术的患者被随机分为MES组、BVS组或UCS组。主要终点为解剖时间。
各组患者及手术特征无差异。BVS组（105分钟）和UCS组（90分钟）的中位解剖时间显著短于MES组（137分钟）（P<0.001）。使用BVS和UCS时，所需额外钛夹显著减少（MES组9个，BVS组0个，UCS组3个；P<0.001），且有失血减少的趋势（分别为125毫升、50毫升和50毫升；P=0.223），吸引液量也减少（425毫升、80毫升和110毫升；P=0.058）。三种器械的总体满意度相似。假设每年中心手术量为200例，使用BVS和UCS进行解剖比使用MES成本显著更低（P=0.009）。
在腹腔镜左半结肠切除术中，BVS和UCS可缩短解剖时间，与MES相比具有成本效益。
