title: Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer.
abstract: OBJECTIVE
  To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US).
  
  
  METHODS
  Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded.
  
  
  RESULTS
  All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P=0.493, P=0.375, P=0.559), operation time (P=0.235), blood loss (P=0.296), anal exhaust time (P=0.431), pelvic drainage volume and VAS in postoperative d 1 (P=0.431, P=0.426) and d 3 (P=0.844, P=0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups.
  
  
  CONCLUSIONS
  ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.
authors.affiliation: Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China. zhoubaojun67@hotmail.com
authors.forename: Bao-Jun
authors.initials: BJ
authors.lastname: Zhou
authors.forename: Wei-Qing
authors.initials: WQ
authors.lastname: Song
authors.forename: Qing-Hui
authors.initials: QH
authors.lastname: Yan
authors.forename: Jian-Hui
authors.initials: JH
authors.lastname: Cai
authors.forename: Feng-An
authors.initials: FA
authors.lastname: Wang
authors.forename: Jin
authors.initials: J
authors.lastname: Liu
authors.forename: Guo-Jian
authors.initials: GJ
authors.lastname: Zhang
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Duan
authors.forename: Zhan-Xue
authors.initials: ZX
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D004564:Electrocoagulation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*