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Principal Investigator and Study Sponsor decided to terminate the study early
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The Whipple procedure is the standard method for therapy for cancerous tumors, inflammation, and stenosis (narrowing) near the head of the pancreas. This is a prospective study to assess whether or not use of the Thunderbeatâ„¢ device may decrease blood loss and postoperative morbidity (the presence of illness or disease). The findings will then be compared to patients whose Whipple procedure will be performed using conventional dissection and hemostasis techniques.
As the pancreas is fed by many vessels, it is necessary to use lots of ligatures, clips and sutures for hemostasis after dissection. This dissection technique is very time consuming and requires numerous changes of instruments. The devices the investigators currently have available for use in the operating suite are EnSeal and LigaSure. A new type of surgical scissors that delivers ultrasonically generated frictional heat energy and electrically generated bipolar energy simultaneously, known as the Thunderbeatâ„¢ (Olympus, Japan), is now an available alternative for dissection and hemostasis.
Thunderbeatâ„¢ was provided FDA clearance in March 2012 for use in open, laparoscopic, and endoscopic surgery, or in any procedure in which cutting, vessel ligation (sealing and cutting), coagulation, grasping and dissection is performed.
The Thunderbeatâ„¢ device provides the first integration of both bipolar and ultrasonic energies delivered simultaneously from a single multi-functional instrument. This integration provides the surgeon the ability to rapidly cut tissue with ultrasonic energy and to create reliable vessel seals with bipolar energy without having to change devices. The current is provided by a special generator and contains a very high capacity with a low voltage. The body's proteins, such as collagen and elastin, are converted so a permanently sealed zone results. As the tissue between the branches is sealed, lateral thermic tissue damages can be limited to a minimum. Several authors have described a tendency of reduced intraoperative blood loss with bipolar energy devices. Other trials show reduced operating time when a bipolar device is utilized in several surgical procedures, such as thyroid, hepatic, urologic, hemorrhoidectomy and gynecology surgery.
Correct dissection in the operating field is very important to avert secondary bleeding or other complications, which might cause re-operation or elevate the patients' morbidity and mortality.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | Active Comparator | In the control group, scissors, ligatures, clips and sutures will be used for dissection and hemostasis as necessary. |
|
| Thunderbeatâ„¢ | Experimental | -In the Thunderbeatâ„¢ group, dissection and hemostasis of vessels will be performed using the Thunderbeatâ„¢ device (Olympus, Japan). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thunderbeat | Device | Thunderbeat uses ultrasonic and high frequency bipolar energy simultaneously to seal and cut tissue compared to placebo comparator. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Operative Blood Loss |
| Day of surgery |
| Post-op Morbidity | -This is a prospective study to evaluate post-operative morbidity following use of the ThunderbeatTM device during the Whipple procedure. This will be compared to patients whose Whipple procedure will be performed using conventional dissection and hemostasis techniques. | Up to 90 days postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Operative Time | -Operation time measured from the beginning of the surgical procedure (incision of the skin) to the end of the surgical procedure (closure of the skin). | Day of surgery |
| Cost Using Thunderbeat Device |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| William Hawkins, M.D. | Washington University School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Washington University School of Medicine | St Louis | Missouri | 63110 | United States |
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| Label | URL |
|---|---|
| Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine | View source |
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There were 44 enrolled to the study. 12 were enrolled but were not randomized to an arm and did not start the study due to reasons such as ineligibility, physician discretion, and because the Thunderbeat was not in the operating room.
The study opened to participant enrollment on 01/01/2015 and closed to participant enrollment on 08/09/2017.
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| ID | Title | Description |
|---|---|---|
| FG000 | Control Group | In the control group, scissors, ligatures, clips and sutures will be used for dissection and hemostasis as necessary. |
| FG001 | Thunderbeatâ„¢ |
|
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Control Group | In the control group, scissors, ligatures, clips and sutures will be used for dissection and hemostasis as necessary. |
| BG001 | Thunderbeatâ„¢ |
|
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Operative Blood Loss |
| Posted | Mean | Standard Deviation | mL | Day of surgery |
|
-Adverse events were collected from the time of surgery through 90 days following completion of surgery.
-Surgical complications will not be considered adverse events associated with the study, unless unanticipated and possibly related to the use of the Thunderbeat device.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Control Group | In the control group, scissors, ligatures, clips and sutures will be used for dissection and hemostasis as necessary. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| William Hawkins, M.D. | Washington University School of Medicine | 314-286-0702 | hawkinsw@wustl.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Oct 14, 2015 | Jul 19, 2018 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D010190 | Pancreatic Neoplasms |
| D001650 | Bile Duct Neoplasms |
| ID | Term |
|---|---|
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004701 | Endocrine Gland Neoplasms |
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| ID | Term |
|---|---|
| D008026 | Ligation |
| D013525 | Surgical Instruments |
| D013537 | Sutures |
| ID | Term |
|---|---|
| D013514 | Surgical Procedures, Operative |
| D013523 | Surgical Equipment |
| D004864 | Equipment and Supplies |
| D053831 | Surgical Fixation Devices |
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The participants will be blinded to the assigned operating technique.
| Standard of care scissors, ligatures, clips, and sutures | Device |
|
-Calculated by the indirect and direct costs during the hospital stay and the costs accumulated 90 days postoperatively
| Up to 90 days postoperatively |
| Anesthesia Time | -Anesthesia time measured from the initiation of anesthesia induction to the time of extubation | Day of surgery |
| Number of Participants Who Experienced Perioperative Complications | -Complications experienced during surgery will be reviewed including:
| Day of surgery |
| Number of Participants Who Experienced Postoperative Complications | -Complications experienced after surgery will be reviewed including:
| Up to 90 days postoperatively |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
| Received Neoadjuvant Therapy | Count of Participants | Participants |
|
| Body Mass Index (BMI) > 30 kg/m^2 | Count of Participants | Participants |
|
|
|
|
| Primary | Post-op Morbidity | -This is a prospective study to evaluate post-operative morbidity following use of the ThunderbeatTM device during the Whipple procedure. This will be compared to patients whose Whipple procedure will be performed using conventional dissection and hemostasis techniques. | Posted | Count of Participants | Participants | Up to 90 days postoperatively |
|
|
|
|
| Secondary | Operative Time | -Operation time measured from the beginning of the surgical procedure (incision of the skin) to the end of the surgical procedure (closure of the skin). | Posted | Median | Full Range | minutes | Day of surgery |
|
|
|
| Secondary | Cost Using Thunderbeat Device | -Calculated by the indirect and direct costs during the hospital stay and the costs accumulated 90 days postoperatively | The data for this outcome measure was not collected. | Posted | Up to 90 days postoperatively |
|
|
| Secondary | Anesthesia Time | -Anesthesia time measured from the initiation of anesthesia induction to the time of extubation | Posted | Mean | Standard Deviation | minutes | Day of surgery |
|
|
|
|
| Secondary | Number of Participants Who Experienced Perioperative Complications | -Complications experienced during surgery will be reviewed including:
| Posted | Count of Participants | Participants | Day of surgery |
|
|
|
|
| Secondary | Number of Participants Who Experienced Postoperative Complications | -Complications experienced after surgery will be reviewed including:
| Posted | Count of Participants | Participants | Up to 90 days postoperatively |
|
|
|
|
| 0 |
| 13 |
| 0 |
| 13 |
| 0 |
| 13 |
| EG001 | Thunderbeatâ„¢ |
| 0 | 19 | 0 | 19 | 0 | 19 |
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| D004066 |
| Digestive System Diseases |
| D010182 | Pancreatic Diseases |
| D004700 | Endocrine System Diseases |
| D001661 | Biliary Tract Neoplasms |
| D001649 | Bile Duct Diseases |
| D001660 | Biliary Tract Diseases |
| Bleeding/hematoma |
|
| Wound infection |
|
| Gastroparesis |
|
| Pancreatic fistula |
|
| Intraabdominal abscess |
|
| Anastomotic leakage |
|
| Blood product transfusion (anemia) |
|
| 0.401 |
| Superiority |
| Statistical analysis #3 is for gastroparesis. | Chi-squared | 0.975 | Superiority |
| Statistical analysis #4 is for pancreatic fistula. | Chi-squared | 0.401 | Superiority |
| Statistical analysis #5 is for intraabdominal abscess. | Chi-squared | 0.219 | Superiority |
| Statistical analysis #6 is for anastomotic leakage. | Chi-squared | 0.401 | Superiority |
| Statistical analysis #7 is for blood product transfusion (anemia). | Chi-squared | 0.219 | Superiority |