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Clipless laparoscopic cholecystectomy using the Harmonic scalpel for cirrhotic patients: a prospective randomized
Ayman El Nakeeb1, Waleed Askar, Ramadan El Lithy
1Department of General Surgery, Mansoura University, Mansoura, Egypt. elnakeebayman@yahoo.com
Surgical Endoscopy
|April 9, 2010
Summary
The Harmonic scalpel (HS) offers a safer and more effective laparoscopic cholecystectomy (LC) for cirrhotic patients compared to traditional methods (TM). HS reduces operative time, blood loss, and postoperative pain, making it a beneficial alternative.
Area of Science:
- Hepatology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy (LC) is increasingly feasible for cirrhotic patients.
- This study compares traditional LC (TM) with Harmonic scalpel (HS) LC.
Purpose of the Study:
- To evaluate the safety and efficacy of Harmonic scalpel (HS) versus traditional method (TM) for laparoscopic cholecystectomy (LC) in cirrhotic patients.
Main Methods:
- Sixty cirrhotic patients underwent LC using TM (clipping and diathermy).
- Sixty cirrhotic patients underwent LC using HS for vessel and duct closure/dissection.
- Perioperative data were collected and analyzed.
Main Results:
- HS procedure was significantly faster (45.17 vs. 69.71 min) with less blood loss (70.13 vs. 133 ml).
- Gallbladder peroration (10% vs. 18.3%) and postoperative pain (VAS 3.07 vs. 4.4) were lower with HS.
- Conversion rates (3.3% vs. 5%) and bile leaks (1.7% vs. 3.3%) were comparable between HS and TM.
Conclusions:
- Laparoscopic cholecystectomy remains challenging in cirrhotic patients.
- Harmonic scalpel (HS) provides effective hemobiliary stasis, proving safe for cirrhotic patients.
- HS offers advantages of shorter operative duration and reduced blood loss compared to TM.