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Meta-Analysis
. 2023 Jun;37(6):4249-4269.
doi: 10.1007/s00464-023-10060-7. Epub 2023 Apr 19.

Use of High Energy Devices (HEDs) versus electrocautery for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials

Monica Ortenzi  1 , Ferdinando Agresta  2 , Nereo Vettoretto  3 , Chiara Gerardi  4 , Eleonora Allocati  4 , Emanuele Botteri  3 , Giulia Montori  2 , Andrea Balla  5 , Alberto Arezzo  6 , Giacomo Piatto  7 , Alberto Sartori  7 , Stavros Antoniou  8 , Mauro Podda  9
Affiliations
Meta-Analysis

Use of High Energy Devices (HEDs) versus electrocautery for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials

Monica Ortenzi et al. Surg Endosc. 2023 Jun.

Abstract

Introduction: According to the literature, there is no clear definition of a High Energy Devices (HEDs), and their proper indications for use are also unclear. Nevertheless, the flourishing market of HEDs could make their choice in daily clinical practice arduous, possibly increasing the risk of improper use for a lack of specific training. At the same time, the diffusion of HEDs impacts the economic asset of the healthcare systems. This study aims to assess the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC).

Materials and methods: On behalf of the Italian Society of Endoscopic Surgery and New Technologies, experts performed a systematic review and meta-analysis and synthesised the evidence assessing the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). Only randomised controlled trials (RCTs) and comparative observational studies were included. Outcomes were: operating time, bleeding, intra-operative and post-operative complications, length of hospital stay, costs, and exposition to surgical smoke. The review was registered on PROSPERO (CRD42021250447).

Results: Twenty-six studies were included: 21 RCTs, one prospective parallel arm comparative non-RCT, and one retrospective cohort study, while three were prospective comparative studies. Most of the studies included laparoscopic cholecystectomy performed in an elective setting. All the studies but three analysed the outcomes deriving from the utilisation of US sources of energy compared to electrocautery. Operative time was significantly shorter in the HED group compared to the electrocautery group (15 studies, 1938 patients; SMD - 1.33; 95% CI - 1.89 to 0.78; I2 = 97%, Random-effect). No other statistically significant differences were found in the other examined variables.

Conclusions: HEDs seem to have a superiority over Electrocautery while performing LC in terms of operative time, while no difference was observed in terms of length of hospitalisation and blood loss. No concerns about safety were raised.

Keywords: Cholecystectomy; High Energy Devices; Laparosocpic surgery.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot originating from the metanalysis of the included RCTs. A: operative time; B: Intra-operative blood loss; C: intra-operative complications; D: Post-operative complications; E: Length of Hospital stay
Fig. 3
Fig. 3
Summary table of the grading of the quality of the evidence
See this image and copyright information in PMC

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