title: Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss.
abstract: BACKGROUND
  Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in laparoscopic procedures. Nevertheless, available evidenced-based data comparing their operative results still are scarce. This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative blood losses in laparoscopic colorectal surgery.
  
  
  METHODS
  The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference in operating time and blood loss between instruments.
  
  
  RESULTS
  Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p < 0.05).
  
  
  CONCLUSIONS
  The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number of patients are required to confirm the results of this metaanalysis.
authors.affiliation: Department of Surgical Sciences, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. Nicola.di.lorenzo@uniroma2.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: Nicola  D
authors.initials: N
authors.lastname: Lorenzo
authors.forename: Luana
authors.initials: L
authors.lastname: Franceschilli
authors.forename: Marco Ettore
authors.initials: ME
authors.lastname: Allaix
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Asimakopoulos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Asimakopoulos
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
mesh_terms: D003107:Colorectal Surgery / Q000379:methods* / Q000706:statistics & numerical data*; D004564:Electrocoagulation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D014464:Ultrasonic Therapy