Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system: A retrospective study based on a tertiary hospital database in China
aRuijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China bTulane School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA, USA
Objective: This study aimed to demonstrate a new surgical shear with an integrated energy system (Harmonic ACE®+7) value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears (CUSs) in a real-world setting.
Methods: This was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE®+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital (the headquarters and Luwan Center in China). Demographic and diagnosis information, intraoperative and postoperative clinical outcomes, and total and categorical costs were collected. Propensity score matching was performed to form the study population for each clinical group. Data were compared between the two groups using t-test and Chi-squared test.
Results: The ACE®+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs (12.8 vs. 19.8, p<0.001), a moderate but not significant difference in mean postoperative drainage duration (6.6 [standard deviation, SD 2.2] days vs. 7.9 [SD 4.1] days, p=0.082), a reduction on mean total drainage volume (275.5 [SD 374.3 mL vs. 492.9 [SD 1495.0] mL, p=0.321), and a lower mean rate of postoperative hemostatic drug usage (16.0% vs. 52.0%, p<0.001). There was no significant difference in total costs between the ACE®+7 and CUS groups.
Conclusion: This study provides real-world data demonstrating that the ACE®+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems. Using the ACE®+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.
. [J]. Asian Journal of Urology, 2024, 11(4): 563-568.
Yi Gao, Yu Zhu, Fukang Sun, Yuan Shao, Tao Huang, Wei He, Xin Xie, Lu Chen, Debra Winberg, Danfeng Xu. Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system: A retrospective study based on a tertiary hospital database in China. Asian Journal of Urology, 2024, 11(4): 563-568.
Re-operation during the LRP procedure hospitalization
0
0
NA
Postoperative readmission within 30 days
0
0
NA
Cost, RMB
ACE®+7 groupa (n=50)
CUS groupa (n=50)
Differenceb
p-Value
Total cost
42 675.0±5134.5
41 426.3±7623.7
1248.7
0.349
Device cost
23 308.4±5702.0
19 467.5±5946.7
3840.9
0.002
Treatment cost
3287.0±3902.9
4412.4±4097.2
-1125.4
0.176
Pharmaceutical cost
6800.3±4169.0
7436.4±4481.4
-636.1
0.478
Nursing cost
555.6±275.8
649.9±352.1
-94.3
0.149
Board and room cost
723.0±636.0
858.7±694.4
-135.7
0.325
Lab test cost
2636.8±805.9
3132.3±1280.2
-495.5
0.025
Examination cost
3591.3±763.4
3792.1±1178.1
-200.8
0.324
Transfusion cost
20.0±141.4
49.2±192.0
-29.2
0.400
Oxygen therapy cost
44.3±8.4
62.9±50.8
-18.6
0.012
TCM cost
996.5±1034.8
765.4±999.0
231.1
0.275
Diagnosis cost
376.0±88.7
384.4±106.0
-8.4
0.677
Other cost
335.8±355.5
415.1±426.8
-79.3
0.328
Total cost excluding intervention costc
38 357.8±5127.1
39 983.1±7618.3
-1625.3
0.223
[1]
Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke D. Assessing the impact of diabetes on quality of life: what have the past 25 years taught us? Diabet Med 2020; 37:483-92.
[2]
Schatten H. Brief overview of prostate cancer statistics, grading, diagnosis and treatment strategies. Adv Exp Med Biol 2018; 1095:1-14.
doi: 10.1007/978-3-319-95693-0_1
pmid: 30229546
[3]
Chaussy CG, Thüroff S. High-intensity focused ultrasound for the treatment of prostate cancer: a review. J Endourol 2017; 31:S30-7. https://doi.org/10.1089/end.2016.0548.
[4]
Yu W, Zhou L. Early diagnosis of prostate cancer from the perspective of Chinese physicians. J Cancer 2020; 11:3264-73.
doi: 10.7150/jca.36697
pmid: 32231732
[5]
Chinese guidelines for diagnosis and treatment of prostate cancer 2018 (English version). Chin J Cancer Res 2019; 31:67-83.
[6]
Kondrup JD, Anderson F, Sylvester B, Branning M. The new HARMONIC ACE®+7 shears: a game changer in ultrasonic hemostasis. Surg Technol Int 2014; 25:24-7.
pmid: 25419951
[7]
Timm RW, Asher RM, Tellio KR, Welling AL, Clymer JW, Amaral JF. Sealing vessels up to 7 mm in diameter solely with ultrasonic technology. Med Devices (Auckl) 2014; 7:263-71.
[8]
Church JT, McLeod JS, Coughlin MA, Bergin IL, Perkins EM, Hoffman HR, et al. An early investigation into possible alternatives to stapled hysterotomy in open fetal surgery. Am J Perinatol 2019; 36:742-50.
doi: 10.1055/s-0038-1673664
pmid: 30372770
[9]
Singleton D, Juncosa-Melvin N, Scoggins P, Paulin-Curlee G, Cummings J, Ricketts C. Intelligent ultrasonic energy: new adaptive tissue technology in HARMONIC shears. J Surg 2020; 8:178-83.
[10]
Zurawin R, Pickron T, Blackstone R. Intelligent ultrasonic energy delivered by HARMONIC® devices with adaptive tissue technology. https://www.academia.edu/32143407/Intelligent_Ultrasonic_Energy_Delivered_by_HARMONIC_devices_with_Adaptive_Tissue_Technology. [Accessed November 1, 2021].
[11]
Benedetto U, Head SJ, Angelini GD, Blackstone EH. Statistical primer: propensity score matching and its alternatives. Eur J Cardio Thorac Surg 2018; 53:1112-7.
[12]
Dokmak S, Ftériche FS, Aussilhou B, Lévy P, Ruszniewski P, Cros J, et al. The largest European single-center experience: 300 laparoscopic pancreatic resections. J Am Coll Surg 2017; 225:226-34.e2. https://doi.org/10.1016/j.jamcollsurg.2017.04.004.
Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc 2006; 38:812-4.
[15]
Franco Moreno AI, Martín Díaz RM, García Navarro MJ. Direct oral anticoagulants: an update. Med Clin 2018; 151:198-206.
[16]
Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet 2019; 394:1192-204.
doi: S0140-6736(19)32136-1
pmid: 31571602
[17]
Zhang J, Xian TZ, Wu MX, Li C, Pan Q, Guo LX. Comparison of the effects of twice-daily exenatide and insulin on carotid intima-media thickness in type 2 diabetes mellitus patients: a 52-week randomized, open-label, controlled trial. Cardiovasc Diabetol 2020; 19:48. https://doi.org/10.1186/s12933-020-01014-7.
doi: 10.1186/s12933-020-01014-7
pmid: 32334592
Luis G. Medina, Randall A. Lee, Valeria Celis, Veronica Rodriguez, Jaime Poncel, Aref S. Sayegh, Rene Sotelo. Robotic management of urinary fistula[J]. Asian Journal of Urology, 2024, 11(3): 357
-365
.
