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A Systematic Review and Meta-analysis

Brent Matthews, MD; Luba Nalysnyk, MD, MPH; Rhonda Estok, RN, BSN; Kyle Fahrbach, PhD; Deirdre Banel, BA; Heather Linz, BA; Jaime Landman, MD

Arch Surg. 2008;143(6):592-600.

Objective  To compare the efficacy and safety of ultrasonic surgical instrumentation with nonultrasonic traditional surgical techniques in various types of surgery.

Data Sources  Electronic searches of MEDLINE, Current Contents, and the Cochrane Library were performed for the period of 1990 to June 1, 2005, using relevant search terms. A manual check of all references in accepted studies was also performed.

Study Selection  Only comparative studies (including randomized and nonrandomized control trials) of ultrasonic surgical instrumentation with nonultrasonic instrumentation were accepted. Procedures of interest included the following: colorectal surgery, gynecologic surgery, head and neck surgery, solid organ surgery, vessel harvesting, cholecystectomy, hemorrhoidectomy, mastectomy, and Nissen fundoplication.

Data Extraction  Two investigators reviewed each study: the first investigator extracted all relevant data, and consensus of each extraction was performed by a second investigator to verify the data. Data were then entered into a database and quality checked for accuracy.

Data Synthesis  Fifty-one primary studies that examined 4902 patients were included in this systematic review, of which 24 were randomized trials and 27 were nonrandomized studies. Comparative meta-analyses for blood loss, surgery time, and hospital length of stay were performed using a random-effects model and stratified by surgery type. Heterogeneity was tested using Q statistics. Statistical significance was defined as P < .05.

Conclusion  Meta-analysis of outcomes comparing ultrasonic with conventional nonultrasonic surgical instrumentation demonstrates significant improvement of several perioperative outcomes in procedure-specific settings when ultrasonic instrumentation is used.

Author Affiliations: Department of Surgery, Washington University School of Medicine, St Louis, Missouri (Dr Matthews); Health Care Analytics Group, United BioSource Corporation, Medford, Massachusetts (Drs Nalysnyk and Fahrbach and Mss Estok, Banel, and Linz); and Department of Urology, Columbia University School of Medicine, New York, New York (Dr Landman).

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