There are no significant differences between LigaSure (Medtronic) and Harmonic (Ethicon Endo-Surgery) devices in terms of operative time, length of hospital stay, rates of intraoperative complications or post-operative complications and re-operation rates among patients undergoing laparoscopic sleeve gastrectomy (LSG), according to a systematic review and meta-analysis by researchers from Kuwait, Jordan and Bahrain.
Although recent studies have investigated the differences between LigaSure and Harmonic devices in terms of intraoperative and postoperative outcomes among patients undergoing LSG, the authors stated that the best available evidence regarding the efficacy of LigaSure compared with Harmonic has not yet been synthesised. Therefore, they conducted this systematic review and meta-analysis of comparative studies to evaluate the efficacy of LigaSure and Harmonic devices in patients undergoing LSG. The primary outcomes assessed were operative time, mean length of hospital stay, and the rates of intraoperative complications such as bleeding, organ injury, leakage and hematoma formation. In addition, they collected data on postoperative complications, including bleeding, abscess formation, leakage, fever (>38°C), and reoperation rates.
The authors noted that the LigaSure device is a handheld electrothermal device designed for sealing vessels up to 7 mm in diameter. It utilizes low voltage and high current to coagulate tissue. This energy application denatures collagen and elastin in vessels and connective tissue, facilitating vessel fusion. LigaSure is equipped with a feedback-controlled response system that automatically stops energy delivery when the seal cycle is finished, ensuring safe operation.
In addition, the Harmonic device utilises ultrasonic vibration to achieve four distinct tissue effects, including cutting, coaptation, coagulation and cavitation. This device is capable of transecting and sealing vessels less than 5 mm in diameter, as well as lymphatics. It is noted for its ability to minimise lateral thermal spread when dissecting near critical structures.
Their literature search identified four studies, consisting of two randomised controlled trials and two retrospective cohort studies, involving a total of 692 patients conducted in Egypt, Turkey, Greece and Italy.
Outcomes
The authors reported that both the operative time and length of hospital stay did not significantly differ between the LigaSure (n=367 patients, MD: -2.32, 95% CI (-10.86, 6.21), p=0.59) and Harmonic groups (n=595 patients, MD: 0.45, 95% CI (-0.64, 1.54), p=0.42), respectively.
In addition, the pooled analysis revealed no significant difference between the LigaSure and Harmonic groups regarding the rate of bleeding (n=689 patients, OR: 1.07, 95% CI (0.75, 1.54), p=0.71), the rate of organ injury (n=267 patients, OR: 1.86, 95% CI (0.56, 6.22), p=0.31), the rate of hematoma formation (n=131 patients, OR: 2.13, 95% CI (0.26, 17.15), p=0.48) and the rate of leakage (n=131 patients, OR: 3.64, 95% CI (0.14, 91.56), p=0.43).
Furthermore, the pooled analysis revealed no significant difference between the LigaSure and Harmonic groups regarding the rate of bleeding (n=689 patients, OR: 1.09, 95% CI (0.33, 3.62), p=0.89), the rate of leakage (n=689 patients, OR: 1.06, 95% CI (0.26, 4.38), p=0.93), the rate of abscess formation (n=689 patients, OR: 1.07, 95% CI (0.32, 3.54], p=0.91), the rate of fever (n=553 patients, OR: 0.64, 95% CI (0.24, 1.77), p=0.40), and the rate of reoperation (n=652 patients, OR: 0.90, 95% CI (0.24, 3.33), p=0.87).
“The findings of this systematic review and meta-analysis suggest that there is no significant difference in terms of operative outcomes and complication rates between LigaSure and Harmonic devices in patients undergoing LSG. This is an important finding, as it indicates that both devices can be considered equally effective and safe for use in LSG procedures,” the authors stated. “The lack of significant differences in operative time and length of hospital stay suggests that both devices are comparable in terms of efficiency and postoperative recovery. This is particularly relevant in the context of bariatric surgery, where minimising the operative time and duration of hospital stay can lead to improved patient outcomes and reduced healthcare costs.”
They add that clinicians can therefore choose between these devices based on factors such as cost, availability, and surgeon preference without compromising patient outcomes.
The findings were reported in the paper, ‘Efficacy of LigaSure Versus Harmonic Devices in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis’, published in Cureus. To access this paper, please click here