Total clipless cholecystectomy by means of harmonic sealing

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Traditional laparoscopic cholecystectomy uses metallic clips for cystic duct and artery closure, posing risks of dislodgement leading to biliary leaks or bleeding.
• Metallic clips, while common, are associated with potential complications in laparoscopic cholecystectomy.

Purpose of the Study:

• To evaluate a prospective case series of total clipless cholecystectomy using harmonic shears for vessel and duct sealing.
• To assess the safety and efficacy of harmonic shears as the sole instrument for cystic duct and artery management during gallbladder removal.

Main Methods:

• A series of 125 patients underwent laparoscopic cholecystectomy with harmonic shears for sealing and dividing the cystic artery and duct.
• Post-operatively, extracted gallbladders underwent a reverse pressure test using CO2 insufflation to evaluate technique safety.

Main Results:

• The primary indication for surgery was gallstones, with a mean operative time of 26 minutes.
• No mortality was observed; overall morbidity was 0.8%, with no instances of hemorrhage or leaks.
• The reverse pressure test confirmed the integrity of the sealed structures, withstanding at least 36 mmHg without leakage.

Conclusions:

• Harmonic shears are an effective and safe instrument for sealing and dividing the cystic artery and duct in laparoscopic cholecystectomy.
• This clipless approach offers advantages in terms of enhanced safety and reduced operative time.