OBJECTIVES:

To evaluate effectiveness and safety of the powered staplers versus manual staplers performing in surgery.

METHODS:

A systematic literature search (CNKI, Wang Fan, Medline, EMBASE and Web of science) was performed to identify clinical studies comparing powered staplers and manual staplers. The primary outcomes including operation time, length of hospital stay, blood loss, anastomotic leakage/air leakage incidence, bleeding/blood transfusion rate, 30-day readmission rate, physician satisfaction and instrument performance index. Meta-analysis was conducted to calculate odds ratio (OR) and mean difference (MD) with corresponding 95% confidence intervals. Further subgroup analysis was conducted to compare powered with manual in linear/vascular staplers and powered with manual in circular staplers.

RESULTS:

A total of 19 studies were included in final analysis, with 6 single-arm studies on powered staplers and 13 studies comparing the use of powered and manual staplers in surgery. Thirteen of the included studies were retrospective studies and 6 were prospective studies. Statistically significant differences were observed in terms of operation time [MD=-13.65, 95CI% (-17.23, -10.06)], length of hospital stay [MD=-1.37, 95CI% (-2.03, -0.71)], anastomotic leakage/air leakage incidence [OR=0.43, 95CI% (0.26, 0.70)], and 30-day readmission rate [OR=0.80, 95%CI (0.71, 0.89)] in favor of powered staplers. No statistically significant differences were observed for blood loss, bleeding/blood transfusion rate. Subgroup analysis showed compared with manual linear/vascular staplers, powered linear/vascular staplers significantly reduced the operation time and 30-day readmission rate, while showed no significant superiority in anastomotic leakage/air leakage incidence and bleeding/blood transfusion rate. Compared with manual circular staplers, powered circular staplers significantly reduced the incidence of anastomotic leakage. Also, existing studies showed powered stapler was more user-friendly, better instrument performance.

CONCLUSIONS:

Our study showed superiority of powered staplers compared to manual staplers in operation time, length of hospital stay, anastomotic leakage/air leakage incidence and 30-day readmission rate. However, further high-quality studies are needed to obtain definitive conclusions.