Abstract
ObjectivesTo compare surgical efficacy and postoperative recovery of ultrasonic scalpel (USS) with conventional techniques for the resection of gastric carcinoma.MethodsA systematic search of major medical databases (PubMed, Embase, CCRT and CNKI) was conducted. Both randomized and non-randomized controlled trials (RCTs and nRCTs) were considered eligible. Operation time (OT), intraoperative blood loss (BL) and postoperative complications (POC) rates as well as postoperative hospitalization days, number of dissected lymph nodes, abdominal drainage volume and time for recovery of gastrointestinal functions were synthesized and compared.ResultsNineteen studies were included (7 RCTs and 12 nRCTs), in which 1930 patients were enrolled totally (946 in the USS group and 984 in the conventional group). Monopolar electrocautery and ligation were used as the conventional methods. Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation. OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = −33.30, 95% CI [−41.75, −24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = −113.42, 95% CI [−142.05, −84.79], p<0.001). Results from RCTs subgroup were consistent with those from nRCTs subgroup. The weighted cumulative risk of POC accounted for 8.9% (0%–25%) and 12.9% (5.5%–45%) in the USS and conventional groups, respectively. Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups. Analysis of secondary outcomes showed the improvements of the USS group over control group regarding the number of dissected lymph nodes, postoperative hospitalization days, abdominal drainage volume and time for recovery of gastrointestinal functions.ConclusionCompared with conventional electrosurgery, the USS is a safe and effective technique with more short-term advantages in open surgery for gastric cancer.
Highlights
Gastric carcinoma (GC) is one of the most common malignancies worldwide with high incidence and cancer-related mortality, especially in Asia [1,2,3]
RCT: randomized controlled trials; nRCT: non-randomized controlled trials. *: both studies were based on the same population. doi:10.1371/journal.pone.0103330.t005
The ultrasonic scalpel (USS) group could decrease by approximately half an hour of Operation time (OT) compared with the control group (MD = 233.30, 95% confidence intervals (CIs) [241.75, 224.86], p,0.001) (Figure 2)
Summary
Gastric carcinoma (GC) is one of the most common malignancies worldwide with high incidence and cancer-related mortality, especially in Asia [1,2,3]. Standardized radical gastrectomy plus lymphadenectomy is the vital procedure for GC, with many operative difficulties [8]. Ultrasonic scalpel (USS) has been widely used in many kinds of surgery like cholecystectomy, colectomy, and glossectomy [8,9,10,11]. With high-frequency sonic wave vibration, approximately 55,000 Hz, the USS can facilitate target tissues concretion and degeneration to accomplish hemostasis [12,13]. Compared with conventional monopolar electrocautery or silk thread ligation, the USS is capable of simplifying surgical procedures and reducing operation time by one-step cutting and coagulation. In view of excellent hemostasis with slight damages to the target tissues and inconspicuous thermal effect to the tissues around the scalpel, the USS has been widely used in laparoscopic and open gastrectomy plus lymphadenectomy for GC patients in the world
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