Monopolar Electrosurgical Scissors Versus Harmonic Scalpel in Robotic Anterior Resection of Rectal Cancer: A Retrospective Cohort Study.

Abstract

Background: Robot-assisted surgical techniques have been introduced in recent years as an alternative minimally invasive approach for colorectal surgery. In practice, we found that the monopolar electrosurgical scissors had its unique advantages in preservation of the pelvic autonomic nerves. We performed a retrospective review of short-term results between using monopolar electrosurgical scissors and harmonic scalpel in robotic anterior resection (using the da Vinci® Surgical System) in rectal cancer patients. Method: Forty-six patients who underwent robotic anterior resection of rectal cancer from June 2016 to January 2018 were retrospectively analyzed and compared. Twenty-two cases underwent resection using monopolar electrosurgical scissors and 24 cases underwent resection using the harmonic scalpel. Patient characteristics, perioperative clinical results, complications, and pathological results were compared between two groups. Results: There were not significantly different patient characteristics between the two groups. The mean operative time was lesser in the monopolar electrosurgical scissors group than in the inharmonic scalpel group [95.59 ± 21.44 minutes versus 81.45 ± 13.89 minutes, P < .01]. The mean estimated blood loss was lesser in the monopolar electrosurgical scissors group than in the inharmonic scalpel group [48.64 ± 19.35 mL versus 61.82 ± 24.23 mL, P = .03]. The complication rate was 18.2% in the monopolar electrosurgical scissors group and 16.7% in the harmonic scalpel group (P = .89). The mean time of postoperational urinary catheter was lesser in the monopolar electrosurgical scissors group [3.73 ± 1.16 days versus 4.59 ± 1.71 days, P = .02]. The day to first passing flatus [3.45 ± 0.80 days versus 3.59 ± 1.14 days, P = .67], feeding time [4.50 ± 1.00 days versus 4.05 ± 1.87 days, P = .35], hospital stay [8.18 ± 3.74 days versus 8.68 ± 3.44 days, P = .52], and the mean number of harvested lymph nodes of detection [13.59 ± 1.71 versus 13.77 ± 1.41, P = .67] were comparable between procedures. Conclusion: Monopolar electrosurgical scissors were used safely and effectively in robotic anterior resection of rectal cancer (using the da Vinci Surgical System). The use of monopolar electrosurgical scissors has benefits in performing blunt and sharp separation in narrow pelvic and cheaper hospitalization expenses.