title: Sutureless open low anterior resection with total mesorectal excision for rectal cancer with the use of the electrothermal bipolar vessel sealing system.
abstract: BACKGROUND
  There is no report of electrothermal bipolar vessel sealer utilization in rectal surgery. The objective here was to evaluate the results of the use of this device in open low anterior resection for rectal cancer regarding reduction of operative time, hemostasis, and postoperative complications compared with the conventional technique. An additional aim was to describe and standardize this operative technique.
  
  
  METHODS
  All open low anterior resections with total mesorectal excision for rectal cancer performed by the same surgical team from January 2003 to December 2003 were reviewed. Patients were divided in two groups: those operated with the classic technique (group A) and those with a bipolar vessel sealer (group B). Main outcomes measured were operative and hospitalization time, intraoperative blood loss, postoperative drainage volume and duration, postoperative complications, perioperative blood transfusions, and final outcome.
  
  
  RESULTS
  Forty-one patients were included (group A: 19, group B: 22). The groups were similar in demographics, TNM classification, number of lymph nodes dissected, complications, blood transfusions, hospital stay, and outcome. Comparing group B with group A, operative time (171+/-10 vs. 203+/-20 min, p=0.002), intraoperative blood loss (20+/-6 vs. 60+/-4 ml, p=0.04), drainage volume (70+/-8 vs. 120+/-10 ml, p=0.001), and drainage duration (1.7+/-0.3 vs. 2.6+/-0.2 days, p=0.01) were significantly reduced.
  
  
  CONCLUSIONS
  The bipolar vessel sealer is a safe and effective adjunct for low anterior resection. The device simplifies the procedure while achieving efficient hemostasis and results in reduced operative time, intraoperative blood loss, and drainage volume and duration.
authors.affiliation: 1st Department of Propedeutic Surgery, Hippocrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. amanouras@hippocratio.gr
authors.forename: Andreas
authors.initials: A
authors.lastname: Manouras
authors.forename: George M
authors.initials: GM
authors.lastname: Filippakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsekouras
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lagoudianakis
authors.forename: Michael
authors.initials: M
authors.lastname: Genetzakis
authors.forename: Haridimos
authors.initials: H
authors.lastname: Markogiannakis
authors.forename: Georgia
authors.initials: G
authors.lastname: Kafiri
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pararas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papanikolaou
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Toutouzas
authors.forename: Stilianos
authors.initials: S
authors.lastname: Katsaragakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D001808:Blood Vessels / Q000033:anatomy & histology; D003082:Colectomy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation; D016896:Treatment Outcome