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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy

W Sasi.

Review published: 2010.

CRD summary

This review concluded that there was a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk and lower pain and nausea scores with dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy. The author considered that many of these potential benefits were subjective and prone to selection and expectation bias. These conclusions appear suitably cautious.

Authors' objectives

To investigate the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy.

Searching

MEDLINE, EMBASE (search dates not reported) and Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2008) were searched for studies of any publication status in any language. Search terms were not reported.

Study selection

Randomised controlled trials (RCTs) that compared ultrasonic dissection with monopolar electrocautery dissection in laparoscopic cholecystectomy were eligible for inclusion.

The included studies were of adults with symptomatic gallstones who underwent laparoscopic cholecystitis. Various devices were used for ultrasonic dissection (the author stated that comparisons could still be made). Outcomes reported were operating time, gallbladder perforation, bleeding, postoperative bile leakage, conversion to open surgery or another laparoscopic procedure, postoperative pain and nausea, length of hospital stay, duration of sick leave, postoperative inflammatory response, perioperative levels of peritoneal growth transforming factor and postoperative complications.

The author did not report how many reviewers performed study selection.

Assessment of study quality

Methodological quality was assessed in terms of sample size, randomisation, allocation concealment and blinding.

The author did not state how many reviewers performed validity assessment.

Data extraction

Appropriate data were extracted to calculate the mean difference and 95% confidence intervals (CIs) for continuous outcomes and odds ratios (ORs) and associated 95% CIs for categorical data.

The author did not state how many reviewers performed data extraction.

Methods of synthesis

Where sufficient data were available, studies were pooled using a fixed-effect model; otherwise, results were described in a narrative synthesis. Heterogeneity was assessed using I2 and Χ2 statistics. Publication bias was investigated using funnel plots.

Results of the review

Seven RCTs were included in the review (n=695). Sample size calculation was performed in two RCTs. None of the trials described the method of randomisation. Five trials reported allocation concealment. Only one study described blinding of caregivers and patients. Length of follow-up was not stated or was unclear.

Ultrasonic dissection was associated with significantly shorter operating time (WMD -8.19 minutes, 95% CI -10.36 to -6.02; five RCTs), fewer gallbladder perforations with bile loss (OR 0.27, 95% CI 0.17 to 0.42; three RCTs), fewer gallbladder perforations with stone loss (OR 0.13, 95% CI 0.04 to 0.47; one RCT), shorter duration of sick leave (WMD -3.8 days, 95% CI -6.21 to -1.39; one RCT), shorter length of hospital stay (WMD -0.30 days, 95% CI -0.51 to -0.09; one RCT).

Ultrasonic dissection was associated with lower postoperative pain scores at 24 hours (WMD -0.94, 95% CI -1.06 to -0.82; two RCTs) and lower postoperative pain scores at the first and fourth hours of recovery (WMD -0.90, 95% CI -1.62 to -0.18 and WMD -1.20, 95% -2.02 to -0.38; one RCT). In one study, postoperative nausea scores were significantly lower at two hours (WMD -0.90, 95% CI -1.62 to -0.18), four hours (WMD -0.80, 95% CI -1.31 to -0.29) and 24 hours (WMD -1.20, 95% CI -2.02 to -0.38). There was no significant difference in the number of patients who experienced clinically significant postoperative nausea or vomiting. Analyses for gallbladder perforations (I2=48.6%) and postoperative pain scores (I2=97.6%) were associated with statistical heterogeneity.

There was no significant difference between ultrasonic dissection and monopolar electrocautery dissection for the outcomes of postoperative bile leakage (two RCTs), conversion to open surgery (two RCTs), need for subhepatic drains (two RCTs) and postoperative complications (two RCTs).

Further laboratory-related measures and subgroup results were reported in the paper.

Authors' conclusions

This review demonstrated a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk and lower pain and nausea scores at different postoperative time points; however, many of these potential benefits were subjective and prone to selection and expectation bias.

CRD commentary

The research question was supported by inclusion criteria for participants, study design and intervention. Searches were restricted by neither publication status nor language. The sources searched were primarily of published studies, so publication bias could not be ruled out. No measures to prevent reviewer error and bias were described for the review process. Study quality was assessed using appropriate criteria and taken into consideration in the analysis. Where present, heterogeneity was explored.

It was appropriate that the author's conclusion highlighted the evidence limitations as the data were sparse for most outcomes and the included studies were at risk of bias.

Implications of the review for practice and research

Practice: The author stated that the main disadvantages were the more difficult manoeuvring technique of the Harmonic scalpel, use of which required an appropriate training programme and cost. The author stated that due to the few trials available and the small patient samples it was inappropriate to advocate use of a single dissection technology.

Research: The author stated a need for further cost-benefit analyses.

Funding

Not stated.

Bibliographic details

Sasi W. Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy. Journal of the Society of Laparoendoscopic Surgeons 2010; 14(1): 23-34. [PMC free article: PMC3021294] [PubMed: 20412640]

Indexing Status

Subject indexing assigned by NLM

MeSH

Cholecystectomy, Laparoscopic; Dissection /instrumentation /methods; Electrosurgery /instrumentation /methods; Humans; Length of Stay; Pain, Postoperative /epidemiology; Randomized Controlled Trials as Topic; Ultrasonics

AccessionNumber

12010005281

Database entry date

18/05/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20412640