Table 1.
Comparative studies on energy devices used in laparoscopic and robotic gynecology surgery
| Authors, year | Study design | Devices compared | Study cohort | Procedure | Blood loss (mL) | Mean operative time (min) | Postoperative pain score | Hospital stay (days) | Complications (n) | Lateral thermal spread: distance (mm) | Significant results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Holub et al., 2000 | Randomized controlled trial | HS vs. CE (monopolar: scissors) | N = 70 (HS: 46, CE: 34) | Laparoscopic hysterectomy |
HS: 166 CE: 170 (p > 0.05) |
HS: 82.9 CE: 90.6 (p = 0.24) |
NA |
HS: 3.1 CE: 3.3 (p > 0.05) |
No statistically significant difference | NA | No statistically significant difference was found between both devices |
| Holub et al., 2001 | Prospective randomized comparative study | HS vs. CE | N = 30 (US: 15, CE: 15) | TLH + LND |
HS: 110 CE: 150 (p = 0.91) |
HS: 138.3 CE: 132.1 (p = 0.96) |
NA |
HS: 3.7 CE: 4.3 (p = 0.23) |
No statistically significant difference | NA | The number of lymph nodes harvested was significantly higher in HS group compared to CE group (18 vs 12.7, respectively; p = 0.05) |
| Holub et al., 2002 | Retrospective comparative study | CE (monopolar: dissector) vs. HS | N = 59 (CE: 32, HS: 27) | LAVH + BSO + LND |
CE: 210.2 HS: 194.2 (p > 0.05) |
CE: 148.2 HS: 155.1 (p > 0.05) |
NA |
CE: 4.2 HS: 3.6 (p = NS) |
No statistically significant difference | HS caused less thermal damage (mm not mentioned) | The number of lymph nodes harvested was significantly higher in HS group compared to CE group (17.5 vs 13.7, respectively; p = 0.0008) |
| Ou et al., 2004 | Retrospective comparative study | CB vs. PK | N = 123 (CB: 73, PK: 50) | TLH |
CB: 172.1 PK: 111.8 (p = 0.021) |
CB: 65.8 PK: 64.8 (p = 0.89) |
NA | NA | No statistically significant difference | NA | Surgeries performed with PK were associated with significantly less blood loss compared to those using CB |
| Wang et al., 2005 | Prospective comparative study | CE vs. PK | N = 62 (CE: 31, PK: 31) | LAVH |
CE: 253.2 PK: 196.8 (p = 0.105) |
CE: 93.4 PK: 87.6 (p = 0.368) |
NA |
CE: 3.0 PK: 3.2 (p = 0.499) |
No statistically significant difference | NA | No significant difference was found between CE and PK |
| Holub et al., 2005 | Retrospective comparative study | CE (monopolar: dissector) vs. HS | N = 119 (CE: 37, HS: 82) | Laparoscopic hysterectomy ± LND |
CE: 205.3 HS: 188.6 (p > 0.05) |
CE: 144.2 HS: 158.7 (p > 0.05) |
NA |
CE: 4.2 HS: 3.4 (p > 0.05) |
No statistically significant difference | NA | The number of lymph nodes harvested was significant higher in HS group compared to CE group (18.1 vs 13.7, respectively; p < 0.001) |
| Lee et al., 2007 | Retrospective case–control study | PK vs. CB | N = 76 (PK: 38, CB: 38) | LRH + LND |
PK: 397.4 CB: 564.5 (p < 0.03) |
PK: 171.8 CB: 228.9 (p < 0.0001) |
NA |
PK: 7.5 CB: 6.9 (p = 0.1) |
Complications within 60 days after surgery: PK: 0 vs. CB: 5 (2 intestinal obstruction, 2 acute renal failure, 1 vesicovaginal fistula) (p < 0.01) |
NA | Compared to CE for performing LRH, PK was associated with significantly shorter operative time, reduced blood loss, and fewer postoperative complications |
| Demirturk et al., 2007 | Retrospective study | LS vs. HS | N = 40 (LS: 21, HS: 19) | TLH |
LS: 87.76 HS: 152.63 (p < 0.001) |
LS: 59.57 HS: 90.95 (p < 0.001) |
NA |
LS: 3.24 HS: 3.42 (p = 0.436) |
NA | NA | LS was significantly associated with shorter operative time and reduce intraoperative bleeding compared to HS |
| Litta et al., 2010 | Randomized controlled study | CE (monopolar: needle) vs. HS | N = 160 (CE: 80, HS: 80) | LM |
Intraoperative blood loss: CE: 182.8 HS: 135.2 (p = 0.004) Total blood loss ( Hb): CE: 1.2 HS: 0.9 (p = 0.03) |
CE: 88.8 HS: 71.8 (p = 0.000) |
24 h after surgery: CE: 5.6 HS: 4.4 (p = 0.00) |
CE: 2.76 HS: 2.27 (p = 0.00) |
No statistically significant difference | NA | HS resulted in significantly shorter overall operative time and was associated with reduced blood loss and postoperative pain compared to CE |
| Janssen et al., 2011 | Randomized controlled trial | LS vs. CB | N = 140 (LS: 70, CB: 70) | Laparoscopic hysterectomy |
LS: 234.1 CB: 273.1 (p = 0.46) |
LS: 148.2 CB: 142.1 (p = 0.46) |
NA |
LS: 2.9 CB: 2.9 (p = 0.94) |
No statistically significant difference | NA | No significant differences in operative time or blood loss were identified between LS and CB in laparoscopic hysterectomy |
| Hsuan su et al., 2011 | Retrospective case–control study | PK vs. CE | N = 194 (PK: 97, CE: 97) | LM |
PK: 190.4 CE: 243.8 (p < 0.025) |
PK: 117.8 CE: 116.9 (p = 0.906) |
NA |
PK: 2.7 CE: 2.8 (p = 0.315) |
No statistically significant difference | NA | PK showed significantly less blood loss in LM when compared to CE |
| Janssen et al., 2012 | Randomized controlled trial | LS vs. CB | N = 100 (LS: 51, CB: 49) | Laparoscopic salpingo-oophorectomy (8 unilateral, 92 bilateral) |
LS: 38.0 CB: 33.3 (p = 0.73) |
LS: 54.6 CB: 58.6 (p = 0.46) |
NA |
LS: 1.3 CB: 1.2 (p = 0.89) |
No statistically significant difference | NA | LS is at least reliable as CB during laparoscopic salpingo-oophorectomy (no significant differences was observed in outcomes between both devices) |
| Cho et al., 2012 | Retrospective case–control study | PK vs. CB | N = 80 (PK: 40, CB: 40) | TLH |
PK: 467.9 CB: 515..3 (p < 0.05) |
PK: 157.3 CB: 173.4 (p < 0.05) |
NA |
PK: 6.5 CB: 6.2 (p > 0.05) |
No statistically significant difference | NA | PK was associated with significantly reduced blood loss and shorter operative time during TLH compared to CB |
| Ashraf Ta et al., 2012 | Randomized clinical trial | HS vs. LS | N = 40 (HS: 20, LS: 20) | LASH |
Hemoglobin drop (%): HS: 3.15 LS: 0.43 (p < 0.005) |
HS: 138.25 LS: 64.15 (p < 0.005) |
NA |
HS: 2.00 LS: 1.65 (p = 0.354) |
No statistically significant difference | NA | In LASH, LS resulted in significantly less blood loss and shorter operative time compared to HS |
| Rothmund et al., 2013 | Randomized controlled trial | ENS vs. CB | N = 160 (ENS: 80, CB: 80) | LASH |
BL < 50 mL: ENS ( N = 72) vs. CB (N = 62) (p = 0.03) BL 50–100 mL: ENS ( N = 8) vs. CB ( N = 18) (p < 0.001) |
ENS: 78.18 vs. CB: 86.30 (p = 0.03) | No statistically significant difference (at 24 h, 48 h and 72 h) | ENS: 2.01 vs. CB: 2.17 (p = 0.03) | No statistically significant difference | NA | ENS was associated with shorter total operative time, less blood loss and hospital stay. This device was at least as reliable as the conventional bipolar coagulation forceps to perform LASH |
| Rothmund et al., 2013 | Randomized controlled trial | HS vs. BiCision |
N = 60 (HS: 30 BC: 30) |
LASH |
Intraoperative BL (score): HS: 1.63 0.49 BiCision: 1.07 (p < 0.0001) |
Preparation time per side (mean): HS: 8.3 BiCision: 8.8 (p = 0.31) |
NA | NA | No complications were observed for both devices | NA | BiCision is at least as reliable as HS for routine gynecological laparoscopic procedures and demonstrates reduced blood loss, improved tissue fixation, and less tissue sticking compared to HS |
| Fagotti et al., 2014 | Randomized controlled trial | TB vs. CE (monopolar: scissors) | N = 50 (TB: 25, CE: 25) | LRH + LND | TB: 50; CE: 50 (p = 0.52) | TB: 85; CE: 115 (p = 0.001) |
24 h after surgery: at rest: TB: 1.96; CE: 3.35 (p = 0.005) After Valsalva maneuver: TB: 3.17; CE: 4.65 (p = 0.008) |
TB: 3 CE: 3 (p = 0.82) |
No statistically significant difference | NA | LRH with LND was performed in a shorter time and less postoperative pain when using TB compared to CE |
| Aytan et al., 2014 | Randomized prospective study | LS vs. ENS vs. PK | N = 45 (LS: 15, ENS: 15, PK: 15) | TLH |
LS: 138.0; ENS: 218.0; PK: 118.0 (p = 0.004) |
LS: 52.4; ENS: 55.7; PK: 51.9 (p = 0.73) |
NA |
LS: 1.1; ENS: 1.4; PK: 1.2 (p = 0.22) |
No statistically significant difference | NA | Both devices had similar results in TLH except ENS group had more blood loss |
| Billow et al., 2014 | Randomized prospective study | CM vs. CO2 laser | N = 21 (CM: 11, CO2 laser: 10) | Colpotomy during RATLH | NA | NA | NA | NA | NA |
Assessment with H&E staining: CO2 laser: 0.7 MP: 1.1 (p = 0.0191) |
CO2 laser resulted in less lateral damage compared to CM |
| Bansal et al., 2014 | Randomized clinical trial | LS vs. HS | N = 242 (LS: 121, HS: 121) | TLH |
LS: 88.74 HS: 140.84 (p < 0.005) |
LS: 76.16 HS: 115.35 (p < 0.005) |
NA |
LS: 1.55 HS: 1.13 (p > 0.005) |
No statistically significant difference | NA | LS was less time-consuming and caused less blood loss compared to HS |
| Choussein et al., 2015 | Retrospective cohort study | CO2 laser vs. HS | N = 236 (CO2 laser: 85, HS: 151) | RALM |
CO2 laser: 96.2 HS: 180.7 (p = 0.95) |
CO2 laser: 182.2 HS: 195.9 (p = 0.55) |
NA |
CO2 laser: 0.15 HS: 0.64 (p = 0.004) |
No statistically significant difference | NA | CO2 laser was at least reliable as HS for RALM |
| Holloran-Schwartz et al., 2016 | Randomized controlled trial | LS vs. CB | N = 46 (LS: 24, CB: 22) | TLH | 75 (not compared between devices) |
Time to desiccation and transection of each side of uterus attachments: LS: 8.4 CB: 14.6 (p < 0.001) |
NA | NA | No statistically significant difference | NA | LS has reduced operative time and total intraoperative direct costs compared to CB |
| Kuo et al., 2017 | Retrospective comparative study | HS vs. CE | N = 124 (HS: 31, CE: 93) | LM |
HS: 300.0 CE: 214.7 (p = 0.063) |
HS: 119.7 CE: 106.0 (p = 0.154) |
NA |
HS: 2.0 CE: 2.5 (p < 0.001) |
HS: 0 vs. CE: 4 (2 low-grade fever, 1 urinary tract infection, 1 subcutaneous ecchymosis at the port site) (p = 0.023) |
NA | HS was associated with a shorter hospital stay but incurred higher hospital costs compared to CE |
| Shiber et al., 2018 | Randomized controlled trial | LS vs. ENS | N = 140 (LS: 70, ENS: 70) | TLH |
LS: 100 ENS: 100 (p = 0.5823) |
Time to bilateral uterine arteries ligation: LS: 30 ENS: 35 (p = 0.0281); Total operative time: LS: 85 ENS: 97 (p = 0.0821) |
NA | NA | No statistically significant difference | NA | ENS was associated with significantly higher rates of device failure (p = 0.003), increased surgeon-perceived workload (p < 0.0001), and a longer time to achieve bilateral ligation of the uterine arteries." |
| Hasanov et al., 2018 | Randomized controlled trial | LS vs. MS | N = 74 (LS: 37; MS: 37) | TLH | LS: 164; MS: 160 (p = 0.36) |
Time to uterine arteries ligation: LS: 22.7; MS: 26.4 (p = 0.89) |
LS: 1; MS: 0 (p = NA) |
LS: 4 MS: 4 (p = NA) |
LS: 0; MS: 4 (p = NA) | NA | MS was at least as reliable as LS, particularly in terms of mean operative time and estimated intraoperative blood loss |
| Taşkin et al., 2018 | Randomized controlled trial | LS vs. CB | N = 68 (LS: 34; CB: 34) | TLH + retroperitoneal LND | LS: 176.1; CB: 182.3 (p = 0.783) | LS: 134.2; CB: 163.5 (p < 0.001) |
8 h after surgery: LS: 3.3; CB: 3.6 (p = 0.278) 24 h after surgery: LS: 2.1; CB: 2.1 (p = 1.0) |
LS: 1.9 CB: 2.1 (p = 0.48) |
No statistically significant difference | NA | LS and CB revealed comparable perioperative outcomes except for operative time that was shorter with LS |
| Choi et al., 2018 | Randomized controlled trial | HS vs. CM (monopolar: scissors) | N = 40 (HS: 20; CM: 20) | Colpotomy during TLH |
HS: 51.4 CM: 46.0 (p = 0.820) |
Colpotomy: HS: 7.2; MD: 4.1 (p < 0.001) Operative time: HS: 68 CM: 59 (p = 0.081) |
NA |
HS: 2.2 CM: 2.3 (p = 0.799) |
No statistically significant difference |
HS: 950 µm MD: 1500 µm (p = 0.037) |
HS showed better laparoscopic visibility and caused significantly less lateral thermal damage during colpotomy compared to CM |
| Beran et al., 2018 | Randomized controlled trial | CM (monopolar: scissors) vs. HS | N = 20 (CM: 10, HS: 10) | Colpotomy during RATLH | 62.5 (not compared between devices) | NA | NA | NA | NA | No statistically significant difference was observed in judge perfusion before or after cuff closure between both devices | Laser angiography can be a feasible tool to evaluate vaginal cuff perfusion during RATLH |
| Li et al., 2018 | Retrospective study | LS vs. CB | N = 756 (LS: 225, CB: 531) | LM | LS: 182.62 CB: 212.99 (p = 0.156) |
LS: 109.09 CB: 114.44 (p = 0.268) |
NA | LS: 2.10 CB: 2.57 (p < 0.001) | No statistically significant difference | NA | LS was associated with a significantly shorter hospital stay. However, CB proved to be significantly more efficient for small and medium-sized myomas and was associated with lower hospital costs |
| Huang et al., 2018 | Retrospective study | CE vs. LS vs. HS | N = 817 (CE: 481, LS: 256, HS: 80) | LM |
CE: 175.4 LS: 201.0 HS: 245.8 (p = 0.003) |
CE: 100.1 LS: 115.7 HS: 130.8 (p < 0.001) |
NA |
CE: 2.5 LS: 2.1 HS: 2.0 (p < 0.001) |
No statistically significant difference | NA | The LS and HS groups experienced significantly greater blood loss and longer operative times; however, both groups had a higher number and larger size of fibroids removed compared to the CE group. In addition, hospital stays were significantly shorter in the LS and HS groups |
| Yuksel et al., 2019 | Randomized controlled trial | LS vs. ENS | N = 132 (LS: 67, ENS: 65) | TLH | LS: 128.2; ENS: 110.1 (p = 0.295) |
Mean operative time (time from transection of round ligament to colpotomy): LS: 25.7; ENS: 38.2 (p = 0.001) Total operative time: LS: 92.3 ENS: 95.1 (p = 0.360) |
NA | NA | No statistically significant difference | NA | LS had statistically significant shorter mean time from transection of round ligament to colpotomy compared to ENS |
| Lee et al., 2019 | Randomized controlled trial | LS vs. CB | N = 71 (LS: 36, CB: 35) | Hysterectomy via transvaginal NOTES |
LS: 269.23 CB: 310.60 (p = 0.445) |
LS: 88.58 CB: 99.54 (p = 0.063) |
At 24 h after surgery: LS: 3.9 CB: 2.5 (p = 0.006) At 36 h after surgery: LS: 2.8, CB: 1.4 (p = 0.002) At 48 h after surgery: LS: 1.3, CB: 1.0 (p = 0.313) |
LS: 3.34 CB: 3.37 (p = 0.858) |
No statistically significant difference | NA | LS is a feasible and safe device and had significantly reduced operative time for hysterectomy via transvaginal NOTES only (without additional procedures, e.g., salpingo-oophorectomy or adhesiolysis) compared to CB (p = 0.029) |
| Wong et al., 2020 | Randomized controlled trial | LS vs. PK | N = 64 (LS: 31, PK: 33) | TLH |
LS: 50 PK: 50 (p = 0.84) |
LS: 63.8; PK: 74.4 (p = 0.03) |
No statistically significant difference | LS: 3; PK: 3 (p = 0.37) | No statistically significant difference | NA | LS was statistically significantly faster to achieve hemostasis during TLH than PK |
| Talwar et al., 2021 | Prospective randomized case–control study | ALAN vs. ENS | N = 100 (ALAN: 50, ENS: 50) | TLH |
ALAN: 111.40 ENS: 107.84 (p = 0.4) |
ALAN: 56.90 ENS: 57.25 (p = 0.9) |
NA | NA | No statistically significant difference | NA | ALAN was at least as reliable as ENS in TLH but more cost-effective |
| Batra et al., 2022 | Randomized controlled trial | CB vs. LS | N = 120 (CB: 60, LS: 60) | TLH |
CB: 145 LS: 141.67 (p = 0.846) |
CB: 142.50 LS: 136.37 (p = 0.002) |
NA |
CB: 2.54 LS: 2.32 (p = 0.128) |
No statistically significant difference | NA | LS was a reliable device with shorter operative times compared to CB |
| Hasabe et al., 2023 | Randomized controlled trial | HS vs. LS vs. bipolar shearer | N = 90 (HS: 30, LS: 30, Bipolar Shearer: 30) | TLH |
Hb (%) HS: 2.15 LS: 1.26 Bipolar shearer: 1.54 |
HS: 68.25 LS: 54.36 Bipolar shearer: 59.34 |
NA |
HS: 1.84 LS: 1.35 Bipolar shearer: 1.60 |
Only related to intraoperative blood loss: HS: 6 LS: 4 bipolar Shearer: 5 |
NA | HS resulted in more blood loss and larger operative time compared to LS and bipolar shearer |
| Gorginzadeh et al., 2024 | Randomized controlled trial | CM (monopolar: hook) vs. HS | N = 78 (CM: 39, HS: 39) | Colpotomy during TLH |
CM: 63.81 HS: 36.71 (p = 0.477) |
Colpotomy duration: CM: 8.47 HS: 9.97 (p = 0.493) Total operative time: CM: 132.95 HS: 119.00 (p = 0.160) |
No statistically significant difference | NA | No statistically significant difference | HS resulted in statistically less lateral thermal damage in the right border of the cervix: HS: 3.08; CM: 3.85 (p = 0.001) | No significant difference was found between CM and HS except that HS was associated with significantly less tissue injury in the right lateral cuff area during colpotomy |
BSO bilateral salpingo-oophorectomy, CB conventional bipolar, CE conventional electrosurgery, CM conventional monopolar, ENS EnSeal, H&E hematoxylin and eosin, HS harmonic scalpel, LAVH laparoscopically assisted vaginal hysterectomy, LASH laparoscopic supracervical hysterectomy, LND lymph node dissection, LRH laparoscopic radical hysterectomy, LS LigaSure, MS MarSeal, NA not applicable/assessed/available, NOTES natural orifice transluminal endoscopic surgery, PK plasmakinetic system, RALM robot-assisted laparoscopic myomectomy, RATLH robot-assisted total laparoscopic hysterectomy, TB thunderbeat, TLH total laparoscopic hysterectomy