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Meta-Analysis
. 2018 Dec;97(51):e13735.
doi: 10.1097/MD.0000000000013735.

A comparative study of ultrasonic scalpel (US) versus conventional metal clips for closure of the cystic duct in laparoscopic cholecystectomy (LC): A meta-analysis

Xiao-Ming Ai, Li-Chen Ho, Nian-Yin Yang, Lu-Lu Han, Jin-Jing Lu, Xiong Yue
Meta-Analysis

A comparative study of ultrasonic scalpel (US) versus conventional metal clips for closure of the cystic duct in laparoscopic cholecystectomy (LC): A meta-analysis

Xiao-Ming Ai et al. Medicine (Baltimore). 2018 Dec.

Abstract

Background: laparoscopic cholecystectomy (LC) has become the gold standard surgery for benign gallbladder diseases. Metal clips are conventionally used to secure the cystic duct and artery, while monopolar electrocautery (ME) predominates during laparoscopic dissection. ultrasonic scalpel (US) has already been explored for sealing the cystic duct and artery as a sole instrument, which has been regarded as a reasonable alternative to clips. The aim of this study was to investigate the safety and effectiveness of US versus clips for securing the cystic duct during LC.

Methods: We identified eligible studies in PubMed, Medline, Cochrane Library, Embase, and SpringerLink up to 1st May 2018, together with the reference lists of original studies. Meta-analysis was conducted using STATA 14.0. Q-based chi-square test and the I statistics were utilized to assess heterogeneity among the included studies. A P-value below .05 was set for statistical significance. Forest plots of combined Hazard ratios (HRs) with 95% confidence intervals (CIs) were also generated.

Results: Eight studies met eligibility criteria in this meta-analysis eventually. A total of 1131 patients were included, of whom 529 were contained in the US group, compared to 602 in the clips group, which showed a significant difference (P = .025) without substantial statistical heterogeneity (I = 0.0%). No statistical significance was revealed regarding age (I = 0.0%, P = .957), and sex (I = 0.0%, P = .578) between both groups. The operative time and hospital stay in the US group were significantly shorter than that in the clips group, with I = 95.0%, P = .000 and I = 72.8%, P = .005, respectively. Concerning conversion (I = 48.6%, P = .084), perforation (I = 12.0%, P = .338), along with bile leakage (I = 0.0% P = .594), and overall morbidity (I = 19.1%, P = .289), comparison between both groups exhibited no statistical significance.

Conclusions: US enabled shorter operative time and hospital stay during LC, compared with clips. Additionally, US was comparable to clips regarding conversion, perforation, along with bile leakage and overall morbidity. Therefore, our meta-analysis concluded that US is clinically superior to the conventional clips in some aspects, or is at least as safe and effective as them, concerning closure of the cystic duct and artery.

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Conflict of interest statement

No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Flow chart depicting the study selection process in the meta-analysis.
Figure 11
Figure 11
Quality assessment of the eligible randomized controlled trials based on the Cochrane risk of bias tool.
Figure 2
Figure 2
Forest plot of comparison of US versus clips in the included studies with respect of number of cases. US = ultrasonic scalpel.
Figure 3
Figure 3
Forest plot of comparison of US versus clips as for age. US = ultrasonic scalpel.
Figure 4
Figure 4
Forest plot of comparison of US versus clips with regard to sex. US = ultrasonic scalpel.
Figure 5
Figure 5
Forest plot of comparison of US versus clips in terms of operative time. US = ultrasonic scalpel.
Figure 6
Figure 6
Forest plot of comparison of US versus clips regarding length of hospital stay. US = ultrasonic scalpel.
Figure 7
Figure 7
Forest plot of comparison of US versus clips with respect of conversion. US = ultrasonic scalpel.
Figure 8
Figure 8
Forest plot of comparison of US versus clips as for perforation. US = ultrasonic scalpel.
Figure 10
Figure 10
Forest plot of comparison of US versus clips as regards overall morbidity. US = ultrasonic scalpel.
Figure 9
Figure 9
Forest plot of comparison of US versus clips in terms of postoperative bile leakage. US = ultrasonic scalpel.
Figure 12
Figure 12
Sensitivity analysis (A) by removing each study sequentially, (B) by omitting the 2 non-RCTs. non-RCT = non-randomized controlled trials.
See this image and copyright information in PMC

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