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Updates in Surgery

, Volume 69, Issue 4, pp 471–477 | Cite as

Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients

  • Diletta CassiniEmail author
  • Michelangelo Miccini
  • Matteo Gregori
  • Farshad Manoochehri
  • Gianandrea Baldazzi
Original Article

Abstract

Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m2) ≥30 were defined as obese, and patients with a BMI (kg/m2) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss results significantly lower in the Caiman group than in the historical one [52 ml vs 93 for RC (p 0.003); 65 vs 120 ml for LC (p 0.001); 93 vs 145 ml for AR (p 0.002) between group A and B, respectively]. No intraoperative complications were recorded in either group. The mean conversion rate was 4.4% (6 patients). There were no statistical differences in intensive care unit (ICU) stay, functional outcomes, mean hospital stay and overall morbidity rate between the two groups. There was no mortality in either group. The use of the Caiman EBVS instrument shows significant advantages with respect to a small number of intraoperative parameters. We can conclude that use of this radiofrequency device, in the laparoscopic approach, offers advantages in terms of lower intraoperative blood loss and shorter operative time in obese patients with colorectal cancer.

Keywords

Laparoscopic resection Colorectal cancer Obese patients Energy source Radiofrequency energy 

Notes

Compliance with ethical standards

Conflict of interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Research involving human participants and/or animals

All procedures performed in our study on human subject were in accordance with the ethical standards of 1964 Helsinki declaration and its later amendments and comparable standards, with the ethical standards of General Medical Council Good Medical Practice and with the current guidelines and best practice standards.

Informed consent

Informed consent was obtained from all individuals included in this retrospective study.

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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Diletta Cassini
    • 1
    Email author
  • Michelangelo Miccini
    • 2
  • Matteo Gregori
    • 2
  • Farshad Manoochehri
    • 1
  • Gianandrea Baldazzi
    • 1
  1. 1.Department of General and Mini-invasive SurgeryPoliclinic of Abano Terme Piazza Cristoforo ColomboAbano Terme (Padua)Italy
  2. 2.First Department of Surgery of the University of Rome “Sapienza” Medical SchoolRomeItaly

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