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.
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Dostalik J, Martinek L, Vavra P, Andel P, Gunka I, Dostalík J, Martínek L, Vávra P, Andel P, Gunka I, Gunková P (2005) Laparoscopic colorectal surgery in obese patients. Obes Surg 15:1328–1331
Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236
Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio CV (2003) Laparoscopic colectomy in obese and non-obese patients. J Gastrointest Surg 7:558–561
Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Kuroyanagi H, Yamaguchi T (2011) Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech 21(6):409–414
Schwandner O, Schiedeck TH, Bruch H (1999) The role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 13:151–156
Tou S, Malik AI, Wexner SD, Nelson RL (2011) Energy source instruments for laparoscopic colectomy. Cochrane Database Syst Rev May 11(5):CD007886
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Clinical outcomes of surgical therapy study group laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246(4):655–662 (discussion 662–4)
Lacy AM, Delgado S, Cadtells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomised clinical trial on laparoscopic-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7
Hazebroek EJ, Color study group (2008) COLOR: a randomised clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953
Manceau G, Panis Y (2016) Laparoscopic colorectal surgery: why, when, how? Updates Surg 68(1):3–5
Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP, Dutton SJ (2014) Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol 32(17):1804–1811. doi:10.1200/JCO.2013.54.3694 (ePub 2014 May 5)
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). LAFA study group. Ann Surg 254(6):868–875
Schwandner O, Farke T, Schiedeck THK, Bruch H-P (2004) Laparoscopic colorectal surgery in obese and non-obese patients. Do differences in body mass indices lead to different outcomes? Surg Endosc 18:1452–1456
Benoist S, Panis Y, Alves A, Valleur P (2000) Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 179:275–281
Yang T, Wei M, He Y, Deng X, Wang Z (2015) Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg 85(7–8):507–513. doi:10.1111/ans.13132 (ePub 2015 Apr 22. Review)
Blee TH, Belzer GE, Lambert PJ (2002) Obesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma? Am Surg 68:163–166
Pikarsky AJ, Saida Y, Yamaguchi T et al (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858
Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241(1):69–76
Zhou I, Wu L, Li X, Wu X, Li B (2012) Outcome of laparoscopic colorectal surgery in obese and non-obese patients: a meta-analysis. Surg Endosc 26(3):783–789
Bissolati M, Orsenigo E, Staudacher C (2016) Minimally invasive approach to colorectal cancer: an evidence-based analysis. Updates Surg 68(1):37–46
Khoury W, Kiran RP, Jessie T et al (2010) Is the laparoscopic approach to colectomy safe for the morbidly obese? Surg Endosc 24:1336–1340
Park JW, Lim SW, Choi HS et al (2010) The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc 24:1679–1685
Bege T, Lelong B, Francon D et al (2009) Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 23:1460–1464
Kamoun S, Alves A, Bretagnol F et al (2009) Outcomes of laparoscopic colorectal surgery in obese and non-obese patients: a case-matched study of 180 patients. Am J Surg 198:450–455
Tsujinaka S, Konishi F, Kawamura YJ et al (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1765
Saiganesh H, Stein DE, Poggio JL (2015) Body mass index predicts operative time in elective colorectal procedures. J Surg Res 197(1):45–49
Janssen PF, Brölmann HA, Huirne JA (2012) Effectiveness of electrothermal bipolar vessel-sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: a systematic review. Surg Endosc 26(10):2892–2901 (ePub 2012 Apr 27. Review)
Campagnacci R, de Sanctis A, Baldarelli M, Rimini M, Lezoche G, Guerrieri M (2007) Electrothermal bipolar vessel sealing device vs ultrasonic coagulating shears in laparoscopic colectomies: a comparative study. Surg Endosc 21(9):1526–1531 (ePub 2007 Feb 8)
Wallwiener CW, Rajab TK, Zubke W, Isaacson KB, Enderle M, Schäller D, Wallwiener M (2008) Thermal conduction, compression, and electrical current—an evaluation of major parameters of electrosurgical vessel sealing in a porcine in vitro model. J Minim Invasive Gynecol 15(5):605–610
Reyes DA, Brown SI, Cochrane L, Motta LS, Cuschieri A (2012) Thermal fusion: effects and interactions of temperature, compression, and duration variables. Surg Endosc 26(12):3626–3633
Conflict of interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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 was obtained from all individuals included in this retrospective study.
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Cassini, D., Miccini, M., Gregori, M. et al. Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients. Updates Surg 69, 471–477 (2017). https://doi.org/10.1007/s13304-017-0454-8
- Laparoscopic resection
- Colorectal cancer
- Obese patients
- Energy source
- Radiofrequency energy