Bipolar versus monopolar cautery scissors for laparoscopic cholecystectomy: a randomized, prospective study

The most efficacious energy source for laparoscopic surgery is constantly being debated. Monopolar electrocautery has gained wide popularity over laser energy because of its lower cost and ease of use. Bipolar current has been extensively used by gynecologists for peritoneoscopic surgery after reports of injuries from monopolar current. The purpose of this study was to compare bipolar scissors (Evershears, Everest Medical) and monopolar scissors (Endoshears, United States Surgical Corporation). Eighty patients were prospectively randomized as to the type of scissors to be used for dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy. The scissors were evaluated subjectively with regard to cutting, coagulation, char, and smoke. The two groups were similar in age, sex, weight, blood loss, and hospital stay. Cutting ability and charring were equal. Coagulation was superior in the monopolar group. Smoke was much less with bipolar energy. Overall satisfaction was similar. We concluded that bipolar scissors are a good, safe device for dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy and compare favorably with monopolar scissors.