A Comparative Study of an Integrated Ultrasonic/Bipolar Sealing Device versus an Articulating Bipolar Sealing Device for Laparoscopic Liver Surgery

Abstract

Introduction: Hemostatic devices (HD) are able to seal and cut tissue with different energy modalities. The aim of this study is comparing the outcome of Thunderbeat (TB), an integrated ultrasonic/bipolar sealing device, versus Enseal (ES), an articulating bipolar sealing device, in laparoscopic liver surgery (LLS). Method: A retrospective analysis of a prospectively maintained database was conducted in a single center from September 2011 to September 2020. The primary endpoint was evaluation of perioperative blood loss (PBL) between the HD. Secondary endpoints consisted of complications, transfusion rate, operative time, hospital stay, and 90-day mortality. Results: 352 patients were identified who underwent LLS, either by using TB (n=105) or ES (n=247). Median PBL was significantly lower with TB (50 mL [20-120] compared to ES (100 mL [50-250] (p<0.0001)). Median operative time was considerably shorter in TB (115 min [45-300]) compared to ES (140 min [40-370]) (p=0.0008). By adjusting for variables influencing PBL in a generalized linear model, the type of HD remained a significant contributing factor in PBL (p=0.0164). The postoperative complication rate was similar for bleeding (TB 0.0% vs. ES 1.2% (p=0.5574)) and biliary leak (TB 1.0% vs. ES 1.6% (p=1.0000)), and there was no significant difference in 90-day mortality (TB 0.0% vs. ES 0.8% (p=1.0000)). Median hospital stay was significantly shorter for TB compared to ES (2 days [1-4] vs. 4 days [3-6] (p<0.0001)). Conclusions: The integrated ultrasonic/bipolar sealing device is superior compared to the articulating bipolar sealing device in LLS in terms of PBL without an increase in complications.