title: Energy Sources for Laparoscopic Colorectal Surgery: Is One Better than the Others?
abstract: BACKGROUND
  Wide acceptance of the laparoscopic approach in both benign and malignant colorectal diseases has led to the development of several multifunctional tools aiming to overcome the limitations of conventional electrosurgery (ES). The aim of this study was to compare ES, ultrasonic coagulating shears (US), electrothermal bipolar vessel sealers (EBVS), and a relatively new energy device that combines both ultrasonic and bipolar energy (Thunderbeat, TB) in terms of safety, efficacy, and cost-effectiveness in patients undergoing laparoscopic colorectal resection (LCR).
  
  
  METHODS
  A review of the literature was performed in Medline and the Cochrane Library. Only randomized controlled trials (RCTs) and cohort studies were considered for inclusion.
  
  
  RESULTS
  Four RCTs, one retrospective, and two prospective cohort studies were eligible for inclusion. Bleeding control was better with US compared with ES and operative time was shorter with both US and EBVS compared with ES. These advantages were more evident in challenging colorectal resections, such as low anterior resections. US and EBVS seemed to be more cost-effective compared with ES, although supporting data are limited. US and EBVS appeared to be equivalent with regard to different outcome parameters. Preliminary data on the efficacy and safety of TB are promising.
  
  
  CONCLUSIONS
  Although US and EBVS have the advantages of less blood loss and/or a shorter operative time compared with ES, the current evidence does not demonstrate which multifunctional instrument is the most effective in LCR. High-quality RCTs are required to confirm the preliminary promising results with the use of TB in LCR.
authors.affiliation: Department of Surgical Sciences, University of Torino , Torino, Italy .
authors.forename: Marco Ettore
authors.initials: ME
authors.lastname: Allaix
authors.affiliation: Department of Surgical Sciences, University of Torino , Torino, Italy .
authors.forename: Edgar J B
authors.initials: EJ
authors.lastname: Furnée
authors.affiliation: Department of Surgical Sciences, University of Torino , Torino, Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Department of Surgical Sciences, University of Torino , Torino, Italy .
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mistrangelo
authors.affiliation: Department of Surgical Sciences, University of Torino , Torino, Italy .
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D015331:Cohort Studies; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D004598:Electrosurgery; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000601:surgery*; D014465:Ultrasonics