Ultrasonically activated shears in extended lymphadenectomy for gastric cancer.

Gastrectomy, followed by extended lymphadenectomy, is the treatment of choice in some stages of advanced gastric cancer. Lymphorrhea, as a result of the many divided lymphatic vessels, increases the morbidity. Ultrasonically activated coagulated shears (UACS) may divide all small vessels followed by immediate sealing of the coapted vessel walls. We designed a prospective randomized study to determine the effectiveness of the UACS versus monopolar electrosurgery in D2 dissection. Forty patients with gastric cancer stage II or stage IIIA were enrolled and randomized into 2 groups of 20 patients each. Group A underwent lymphatic dissection with monopolar cautery. Group B underwent lymphatic dissection with UACS. Subhepatic and left sudiaphragmatic closed drains were left until lymphorrhea and/or oozing stopped. Total gastrectomy was performed in 16 patients of group A and 14 of group B; subtotal gastrectomy was performed in 4 patients in group A and 6 patients in group B. The drains were removed after 6-17 days (mean 9.7 +/- 2.9) in group Aand after 4-8 days (mean 5.6 +/- 1.2) in group B(p < 0.001). The total amount of drained fluid was 300-2050 ml (mean 985 +/- 602) in group A and 230-1080 ml (mean 480 +/- 242) in group B (p < 0.002). Eight patients in group A and 5 in group B had postoperative fever, while 3 and 1 patients, respectively, had wound infections. In conclusion the use of UACS is a safe method of lymphatic dissection which reduces operative blood loss, postoperative lymphorrhea, blood transfusions,and hospital stay.