Laparoscopic Bowel Resection: A Comparison of Three Ultrasonically Activated Devices

BACKGROUND AND OBJECTIVES: To compare resection time and collateral thermal damage of 3 currently available ultrasonically activated devices in laparoscopic small bowel surgery. METHODS: AutoSonix®, SonoSurg®, and UltraCision® were compared in laparoscopic small bowel mesentery resection in a porcine model. A resection was defined as 12 endarcade arteries supplying the intended bowel segment. Vessels were divided 1 cm off the bowel wall. AutoSonix®, SonoSurg®, and UltraCision® were comparable for blade length and type, cutting mechanism, handle ergonomics, and vibration amplitude, but not well matched for vibration frequency (55.5;23.5;55.5 kHz), working shaft diameter (5;11;10mm) and length (29;33;34cm), respectively. A sample size of 114 was calculated to detect a 25% difference with 90% power at a 5% significance level. Resections were allocated to devices by block randomization. Analysis of variance and pairwise Scheffe tests were used for multiple comparisons, and a Kaplan-Meier plot was drawn to confirm differences in resection time with each device. A pathologist blind to the devices evaluated bowel wall biopsies for thermal damage. RESULTS: Procedures as allocated comprised 114 resections (38 with each device). UltraCision® median resection time of 5160 (range 2340-7860) seconds was significantly longer (P=0.0001). The difference in resection time between AutoSonix® (median 3420, range 1860-8760 s) and SonoSurg® (median 3660, range 1800-6900 s) did not reach statistical significance. A microscopy revealed no thermal damage. CONCLUSIONS: Laparoscopic resection time for porcine bowel mesentery was shorter with AutoSonix® or SonoSurg® than with UltraCision®, and no thermal damage to the bowel wall was found.