Harmonic scalpel, the tool for new age laparoscopic cholecystectomy


  • Navneet Sharma Department of Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Arun Chauhan Department of Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Ved Sharma Department of Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Arun Gupta Department of Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Sucheta Pathania Medical officer, Department of Health and Family Welfare, Himachal Pradesh, India




Clipless, Gall bladder, Harmonic scalpel, Laparoscopic cholecystectomy


Background: Among the various abdominal procedures, operations performed on the biliary tract are the most common and cholecystectomy is the commonest performed surgical procedure amongst them. Currently laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease. Cholecystectomy done by harmonic scalpel is an attractive alternative technique being more cost effective and having equivalent results in regard to post-operative recovery and pain as compared to standard laparoscopic procedure. The objective of this study was to compare Clipless (Harmonic scalpel assisted) and Conventional Laparoscopic Cholecystectomy.

Methods: Patients with a diagnosis of symptomatic cholelithiasis were included in the present study. Patients were divided randomly into two groups. The control group (Group-A) underwent conventional LC using mono-polar electro-surgery for dissection of gallbladder bed and clips for ligation of cystic duct and artery while the study group (Group-B) underwent LC using the harmonic scalpel. The harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the gallbladder bed.

Results: The mean duration of surgery in the conventional LC group was found to be 46 min 50 sec and 33 min 10 sec in the clipless LC group, the difference being statistically significant (p <0.05). Perforation of gall bladder occurred in 12 cases in conventional LC group as compared to 2 cases in clipless laparoscopic (P <0.05).

Conclusions: The clipless LC approach has a definite edge over conventional LC, in regard to lesser duration of surgery, fewer operative complications and shorter post-operative hospital stay.


Ganey JB, Johnson PA, Prillaman PE, McSwain GR. Cholecystectomy: Clinical experience with large series. Am J Surg. 1986;151:352-7.

Hen YML, Cmey LC. Complications of cholecystectomy. Surg Clin North Am. 1983;63:1191-204.

Morgensterll L, Vong L, Berci G. 1200 Open cholecystectomies before the laparoscopic era: A standard for comparison. Arch Surg. 1992;127:400-3.

Meye KA, Capos IN, Mittlepunkt AI. Personal experience with 1261 cases of acute and chronic cholecystitis and cholelithiasis. Surg. 1967;61:661-8.

DeMarco A, Nance F, Cohn I Jr. Chronic cholecystitis: experience in a large charity institution. Surg. 1968;63:750-6.

Arnold DJ. 28,621 cholecystectomies in Ohio: results of a survey in Ohio hospitals by the Gallbladder Survey Committee, Ohio Chapter, American College of Surgeons. Am J Surg. 1970;119(6):714-7.

Pickleman J, Gonzalez R. Improving results of cholecystectomy. Arch Surg. 1986;121:930-4.

Janssen IMC, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JHG, Van Goor H. Randomized clinical trial of ultrasonic versus electro cautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg. 2003;90:799-803.

Huang X, Feng Y, Huang Z. Complications of laparoscopic cholecystectomy in china: an analysis of 39238 cases. Chin Med J (Engl). 1997;110:704-6.

Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101-25.

Westervelt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel. JSLS. 2004;8(3):283-5.

Zaidi AH, Haleem A, Rana S. Use of harmonic scalpel in laparoscopic cholecystectomy. Pak Arm F Med J. 2011;31(1).

Gelmini R, Franzoni C, Zona S, Andreotti A, Saviano M. Laparoscopic cholecystectomy with harmonic scalpel. JSLS. 2010;14(1):14-9.

Bessa S, Fayoumi T, Katri K, Awad A. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendoscopic Advanced Surg Tech. 2008;18:4.






Original Research Articles