Ultrasonically Activated Shears Reduce Blood Loss without Increasing Inflammatory Reactions in Open Distal Gastrectomy for Cancer: A Randomized Controlled Study.
BACKGROUND
Previous studies regarding ultrasonically activated shears (UAS) were performed without controlled surgical procedures or consideration of potential thermal injury due to high temperature of active blade of UAS. The purpose of this study was to evaluate the efficacy and safety of UAS through a comparison with conventional monopolar electrocautery (CME) in open distal gastrectomy for gastric cancer.


METHODS
From October 2011 to November 2012, 56 gastric cancer patients eligible for open distal gastrectomy were randomized into UAS or CME groups. Primary endpoints were estimated blood loss (EBL) during surgery and amount of drainage through the fifth postoperative day. Secondary endpoints were operation time, length of hospital stay, postoperative morbidity, changes in cytokine levels in serum, peritoneal irrigation saline, and peritoneal drainage, and inflammatory markers of serum. (Registration-number of ClinicalTrials.gov: NCT01971775).


RESULTS
EBL was lower in the UAS group than that in the CME group (339.8 ± 201.2 vs. 428.6 ± 165.8 mL, p = 0.021). However, the amount of postoperative drainage was not significantly different between the two groups. Although the complication rate was not different between the two groups, there were three cases of intra-abdominal bleeding requiring transfusion only in the CME group. Inflammatory markers from the cytokine assays and serum laboratory tests showed no significant differences between the two groups.


CONCLUSIONS
UAS reduced EBL without increasing inflammatory reactions.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Seung-Young
SY
Oh
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Boram
B
Choi
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Kyung-Goo
KG
Lee
Department of Nursing, Seoul National University Hospital, Seoul, Korea.
Hwi-Nyeong
HN
Choe
Department of Nursing, Seoul National University Hospital, Seoul, Korea.
Hye-Joo
HJ
Lee
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Yun-Suhk
YS
Suh
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Seong-Ho
SH
Kong
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Hyuk-Joon
HJ
Lee
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.|Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
Woo Ho
WH
Kim
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. hkyang@snu.ac.kr.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. hkyang@snu.ac.kr.
Han-Kwang
HK
Yang
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D059708:Ultrasonic Surgical Procedures / Q000379:methods*