Tou Samson, Malik Ali Irqam, Wexner Steven D, Nelson Richard L
Department of Colorectal Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville West, Adelaide, South Australia, Australia, 5011.
Cochrane Database Syst Rev. 2011 May 11(5):CD007886. doi: 10.1002/14651858.CD007886.pub2.
Colectomy is a common procedures for both benign and malignant conditions. Increasingly more colectomy has been performed laparoscopically and there are several available instruments being used for this procedure. Of which three common dissecting instruments are: monopolar electrocautery scissors (MES), ultrasonic coagulating shears (UCS) and electrothermal bipolar vessel sealers (EBVS).
The aim is to assess the safety and effectiveness of these instruments.
Studies were identified from PubMed, EMBASE, Cochrane Controlled Trials Register, Cochrane Colorectal Cancer Group Trials Register. Major journals were specifically hand searched. All randomised controlled trials were included.
All patients underwent elective laparoscopic or laparoscopic-assisted right, left or total colectomy or anterior resection for either benign or malignant conditions were included in the study.
Two reviewers independently selected studies from the literature searches, assessed the methodological quality of the trials and extracted data. The three primary outcomes were: overall blood loss, complications and operating time.
Six randomised controlled trials including 446 participants. Two trials compared three types of instruments (MES vs UCS vs EBVS). One trial compared MES and UCS. One trial compared UCS and EBVS. One trial compared 5 mm versus 10 mm EBVS. One trial compared the technique of laparoscopic staplers and clips versus EBVS in pedicle ligation during laparoscopic colectomy. The limitation of this review is the heterogeneity of the trials included. The measured outcomes were covered by one to three studies with small number of participants. With this in mind, there was significant less blood loss in UCS compared to MES. The operating time was significantly shorter with the use of EBVS than MES. No difference between UCS and EBVS apart from EBVS appeared to be handling better than UCS in one study. Haemostatic control was better in UCS and EBVS over MES. No definite conclusion on the cost difference between these three instrument but this would lie in the balance between the instrument cost and the operating time. The handling of 5 mm EBVS was better than 10 mm and its main advantage was trocar flexibility. Laparoscopic staplers/clips used for pedicle ligation in colectomy associated with more failure in vessel ligation and cost more when compared to EBVS.
AUTHORS' CONCLUSIONS: The limitations of this review is the small number of trials and heterogeneity of the studies included. With the current evidence it is not possible to demonstrate which is the best instrument in laparoscopic colectomy. Hopefully more data would follow and subsequent updates of this review could become more informative.
结肠切除术是治疗良性和恶性疾病的常见手术。越来越多的结肠切除术通过腹腔镜进行，并且有几种可用的器械用于该手术。其中三种常见的解剖器械是：单极电凝剪刀（MES）、超声凝固剪刀（UCS）和电热双极血管闭合器（EBVS）。
旨在评估这些器械的安全性和有效性。
从PubMed、EMBASE、Cochrane对照试验注册库、Cochrane结直肠癌组试验注册库中检索研究。对主要期刊进行了专门的手工检索。纳入所有随机对照试验。
所有因良性或恶性疾病接受择期腹腔镜或腹腔镜辅助右半结肠切除术、左半结肠切除术、全结肠切除术或前切除术的患者均纳入研究。
两名评价者独立从文献检索中选择研究，评估试验的方法学质量并提取数据。三个主要结局指标为：总失血量、并发症和手术时间。
六项随机对照试验，共446名参与者。两项试验比较了三种器械类型（MES vs UCS vs EBVS）。一项试验比较了MES和UCS。一项试验比较了UCS和EBVS。一项试验比较了5mm与10mm EBVS。一项试验比较了腹腔镜结肠切除术中腹腔镜吻合器和钛夹与EBVS在蒂结扎中的技术。本综述的局限性在于纳入试验的异质性。所测量的结局指标由一至三项研究涵盖，参与者数量较少。考虑到这一点，与MES相比，UCS的失血量明显更少。使用EBVS时的手术时间明显短于MES。除了在一项研究中EBVS的操作似乎比UCS更好外，UCS和EBVS之间没有差异。UCS和EBVS的止血控制优于MES。关于这三种器械成本差异尚无明确结论，但这取决于器械成本与手术时间之间的平衡。5mm EBVS的操作优于10mm EBVS，其主要优点是套管针的灵活性。与EBVS相比，用于结肠切除术蒂结扎的腹腔镜吻合器/钛夹导致血管结扎失败更多且成本更高。
本综述的局限性在于试验数量少且纳入研究存在异质性。根据目前的证据，无法证明哪种器械是腹腔镜结肠切除术中的最佳器械。希望能有更多数据，本综述的后续更新可能会提供更多信息。
