Comparison of Electrocautery Versus Ultrasonic Shears in Laparoscopic Nephrectomy: a Pilot Randomized Controlled Trial

Abstract

Novel energy devices such as ultrasonic shears (US) are widely used in laparoscopic surgery due to convenience and outcomes. However, these are expensive and add to the procedure cost. Electrocautery (EC) can often provide similar surgical outcomes and existing literature in unclear on the benefits of one over the other. We conducted a randomized trial between US and EC use in laparoscopic nephrectomy. Twenty patients undergoing laparoscopic nephrectomy between January 2019 and January 2020 at our tertiary referral center were included. Patients were randomly allocated in 2 groups according to energy used, i.e., EC and US. We assessed operative time, blood loss, intra- and postoperative complications, drain output and duration, hospital stay, readmission rates within 30 days of discharge, and surgeon satisfaction with the instruments used. The mean operative time and estimated blood loss were 113 min and 170 ml in EC group while 106 min and 180 ml in US group (p > 0.05). The mean change in hematocrit values after surgery were 6.12% and 5.27% in EC and US group, respectively (p = 0.812). There were no significant differences in mean hospital stay (2.7 in EC group, 2 days in US group), drain output (35.6 ml in EC and 26.3 ml in US group), and drain duration (1.7 days in EC and 1.9 days in US group). One patient in EC group had retroperitoneal hematoma due to Veress needle injury. Similarly only 1 patient in US group had severe intraoperative bleeding requiring conversion to open procedure. Two patients in the EC group had postoperative complications, i.e., fever and purulent collection under surgical site. Electrocautery and ultrasonic shears appear to be comparable in efficacy and safety in laparoscopic nephrectomy. However larger prospective studies are required to confirm our findings.