A Randomized Clinical Trial Comparing Cost and Effectiveness of Bipolar Vessel Sealers to Clips and Vascular Staplers in Straight Laparoscopic Colectomy

Introduction: This study compares the costs and effectiveness of two standard techniques for vascular control in straight laparoscopic colectomy.
Methods: Patients scheduled for laparoscopic colectomy were randomized to bipolar vessel sealer (BVS; Ligasure Atlas, Covidien) or laparoscopic clips and vascular staplers (LCS). Time and ability to control the main vascular pedicles were recorded. Costs of disposable instruments were evaluated. Diagnosis, type and duration of procedure, body mass index (BMI), presence of adhesions, abscess or phlegmon, as well as estimated blood loss (EBL) were used to adjust multivariate regression models and evaluate effectiveness and costs.
Results: Of 59 randomized patients, there were 32 BVS and 27 LCS cases. Diagnosis, occurrence and severity of adhesions and abscess, median BMI (27kg/m2), operative time (170min), EBL (50ml), and length of stay (3 days) were similar between groups. Twenty right colectomies, 31 left colectomies and 8 total colectomies were performed for diverticulitis (16), neoplasia (33), and colitis (10). There were no conversions. Both diagnosis and procedure were significant predictors of the duration of surgery, while randomization to either group was not. An average of 2.4 laparoscopic clips and 1.6 vascular staplers were used per procedure in the LCS group. Overall, there was no significant difference in costs of disposable instruments. Two instruments failures occurred in the LCS arm, while one BVS had to be replaced (p=ns). BVS decreased operative time by 106 minutes (p=0.04) for total colectomies and by 33 minutes (p=0.04) for right colectomies. Moreover, the BVS reduced instrument costs by $446.9 in total colectomies and by $85.9 (p=0.07) in right colectomies. There were no significant differences in operative time and cost for left colectomies.
Conclusion: Bipolar vessel sealers do not change operative time or instrument cost for laparoscopic colectomy. BVS does significantly reduce the operative time and instrument cost for total and right colectomies and presents a better cost-effectiveness profile than laparoscopic clips and vascular staplers.

Session: Podium Presentation

Program Number: S122