Energy Sources for Laparoscopic Colorectal Surgery: Is One Better than the Others?

BACKGROUND: Wide acceptance of the laparoscopic approach in both benign and malignant colorectal diseases has led to the development of several multifunctional tools aiming to overcome the limitations of conventional electrosurgery (ES). The aim of this study was to compare ES, ultrasonic coagulating shears (US), electrothermal bipolar vessel sealers (EBVS), and a relatively new energy device that combines both ultrasonic and bipolar energy (Thunderbeat, TB) in terms of safety, efficacy, and cost-effectiveness in patients undergoing laparoscopic colorectal resection (LCR).

MATERIALS AND METHODS: A review of the literature was performed in Medline and the Cochrane Library. Only randomized controlled trials (RCTs) and cohort studies were considered for inclusion.

RESULTS: Four RCTs, one retrospective, and two prospective cohort studies were eligible for inclusion. Bleeding control was better with US compared with ES and operative time was shorter with both US and EBVS compared with ES. These advantages were more evident in challenging colorectal resections, such as low anterior resections. US and EBVS seemed to be more cost-effective compared with ES, although supporting data are limited. US and EBVS appeared to be equivalent with regard to different outcome parameters. Preliminary data on the efficacy and safety of TB are promising.

CONCLUSION: Although US and EBVS have the advantages of less blood loss and/or a shorter operative time compared with ES, the current evidence does not demonstrate which multifunctional instrument is the most effective in LCR. High-quality RCTs are required to confirm the preliminary promising results with the use of TB in LCR.