title: Safety and effectiveness of 5-mm and 10-mm electrothermal bipolar vessel sealers (LigaSure) in laparoscopic resections for sigmoid colon and rectal cancers.
abstract: BACKGROUND
  LigaSure™ (Covidien, Mansfield, MA) has been used in cases undergoing laparoscopic colon and rectal resections. This study aims to analyze the efficacy and safety of the 5-mm and 10-mm devices.
  
  
  METHODS
  Patients who received a laparoscopic or hand-assisted laparoscopic operation for a tumor located in the sigmoid colon or rectum since 2006 were abstracted from a prospectively designed database, and findings were analyzed in two groups based on size of the device used during the procedure. The videotapes of the procedures were watched, and operation reports were read to obtain further information on specific intra- and postoperative complications. Demographics, tumor and operation-related information, and postoperative data were compared.
  
  
  RESULTS
  Among 215 (128 [59.5%] males; median age, 59.5±13.8 years) patients, data obtained from the 5-mm (n=32) and 10-mm (n=183) groups were identical regarding demographics and data related to tumor (localization and stage) and operation (number of harvested lymph nodes, conversion rates, operation time, intraoperative bleeding, transfusion requirement, reoperation rates, complications, 30-day mortality, and length of hospital stay). However, more patients underwent an anterior resection in the 10-mm group than in the 5-mm group (31.7% versus 15.6%, P<.05). Further analyses found device-related bleeding in 8 (3.7%) cases (2 [6.3%] versus 6 [3.3%] in the 5-mm versus 10-mm group, respectively, P>.05), requiring further attempts for hemorrhage control (n=6), conversion to open surgery (n=1), or relaparotomy (n=1).
  
  
  CONCLUSIONS
  The 5-mm and 10-mm LigaSure devices are similarly effective and safe during laparoscopic sigmoid colon and rectal resections. Severe bleeding from larger vessels may be observed, requiring conversion to open surgery or relaparotomy.
authors.affiliation: General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey. cemgezen@hotmail.com
authors.forename: Cem
authors.initials: C
authors.lastname: Gezen
authors.forename: Metin
authors.initials: M
authors.lastname: Kement
authors.forename: Yunus E
authors.initials: YE
authors.lastname: Altuntas
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.forename: Nuri
authors.initials: N
authors.lastname: Okkabaz
authors.forename: Osman
authors.initials: O
authors.lastname: Civil
authors.forename: Selahattin
authors.initials: S
authors.lastname: Vural
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
mesh_terms: D016009:Chi-Square Distribution; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004598:Electrosurgery / Q000295:instrumentation*; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome