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Clipless laparoscopic cholecystectomy by ultrasonic dissection.

Samer S Bessa¹, Tarek A Al-Fayoumi, Khaled M Katri

¹Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. samerbessa@gmail.com

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A

|August 30, 2008

Summary

The harmonic shears are as safe and effective as clip and cautery for laparoscopic cholecystectomy. This method offers shorter operative times and less gallbladder perforation during cystic duct closure.

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Area of Science:

Minimally Invasive Surgery
Surgical Technology
Gastrointestinal Surgery

Background:

Ultrasonically activated devices show promise in laparoscopic cholecystectomy.
Comparison of harmonic shears versus clip and cautery for cystic duct management is needed.

Purpose of the Study:

To compare the safety and efficacy of harmonic shears against clip and cautery for cystic duct closure during laparoscopic cholecystectomy.

Main Methods:

Prospective study of 120 patients with symptomatic gallstone disease.
Randomized assignment to either harmonic scalpel (HS) or clip and cautery (C&C) groups (60 patients each).
Cystic duct closure and division performed solely by assigned technique.

Main Results:

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No bile leaks or bile-duct injuries observed in either group.
Gallbladder perforation occurred significantly less in the HS group (10%) compared to C&C (30%; P=0.002).
Median operative time was significantly shorter in the HS group (32 minutes) versus C&C (40 minutes; P=0.000).

Conclusions:

Harmonic shears are safe and effective for cystic duct management in laparoscopic cholecystectomy.
Harmonic shears offer advantages over clip and cautery, including reduced operative time and lower gallbladder perforation rates.
Harmonic shears represent a superior alternative to high-frequency monopolar technology for this procedure.