Comparative study to evaluate ultrasonic verses monopolar electrocautery dissection of gall bladder in laparoscopic cholecystectomy
Keywords:Laparoscopic cholecystectomy, Monopolar electrocautery, Ultrasonic scalpel
Background: Gallstones are one of the most common routinely encountered surgical problem in the developed world. Laparoscopic cholecystectomy being the gold standard surgery for gall stones has been modified various times using different instruments in order to improve intraoperative and postoperative outcomes. The aim of the study was to see clinical outcomes of ultrasonic scalpel verses monopolar electrocautery in dissection of gall bladder in laparoscopic cholecystectomy.
Methods: A prospective randomized controlled study was done with total 100 patients in which 50 patients underwent laparoscopic cholecystectomy via ultrasonic scalpel while rest 50 patients were operated using monopolar electrocautery. The study was conducted for a period of eighteen months and clinical outcomes were studied in terms of operative time, frequency of lens cleaning, gall bladder perforation, biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay.
Results: The two groups were comparable in terms of demographic profile considering age and sex distribution. However, there was a statistically significant reduction in operative time, frequency of lens cleaning and gall bladder perforation in group A (harmonic scalpel) as compared to group B (electrocautery).
Conclusions: Harmonic scalpel is not only a safe and effective instrument but also a reliable alternative to electrocautery. Even though the study revealed no significant difference in biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay but it can significantly reduce operative time and incidence of gall bladder perforation. Thus, it can improve the operative course in laparoscopic cholecystectomy.
Nakeeb A, Steven A, Hency A. Calculous biliary disease. Greenfield surgery. 6th ed. Philadelphia, PA: Williams & Wilkins; 2016: 978-992.
Keus F, Jong JA, Gooszen HG, Laarhoven CJ. Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;(4):6229.
Soper NJ, Barteau JA, Clayman RV, Becich MJ. Safety and efficacy of laparoscopic cholecystectomy using monopolar electrocautery in the porcine model. Surg Laparosc Endosc. 1991;1(1):17-22.
Wu JS, Luttmann DR, Meininger TA, Soper NJ. Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery. Surg Endosc. 1997;11(11):1075-9.
Westervelt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel. JSLS. 2004;8(3):283-5.
Humes DJ, Ahmed I, Lobo DN. The pedicle effect and direct coupling: delayed thermal injuries to the bile duct after laparoscopic cholecystectomy. Arch Surg. 2010;145(1):96-8.
Lenihan JP, Kovanda C, Cammarano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. Am J Obstet Gynecol. 2004;190(6):1714-20.
Sasi W. Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy. JSLS. 2010;14(1):23-34.
Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH. Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae. Am Surg. 1999;65(10):944-8.
Litta P, Fantinato S, Calonaci F, Cosmi E, Filippeschi M, Zerbetto I, et al. A randomized controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy. Fertil Steril. 2010;94(5):1882-6.
Power C, Maguire D, McAnena OJ, Calleary J. Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy. Surg Endosc. 2000;14(11):1070-3.
Jain SK, Tanwar R, Kaza RC, Agarwal PN. A prospective, randomized study of comparison of clipless cholecystectomy with conventional laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2011;21(3):203-8.
Lee SJ, Park KH. Ultrasonic energy in endoscopic surgery. Yonsei Med J. 1999;40(6):545-9.
Janssen IM, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JH, Goor H. Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg. 2003;90(7):799-803.
Mahabaleshwar V, Kaman L, Iqbal J, Singh R. Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial. Can J Surg. 2012;55(5):307-11.
Mukesh KS, Vijayata S, Mohinder KG, Deepak S. Triple ligation technique of clipless laparoscopic cholecystectomy: a spanner especially for complicated cholecystitis. Int J Adv Med. 2017;4:1358-63.
Lamont T, Watts F, Panesar S, Fie J, Matthew D. Early detection of complications after laparoscopic surgery: summary of a safety report from the National Patient Safety Agency. BMJ. 2011;342:7221.
Kandil T, Nakeeb A, Hefnawy E. Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg. 2010;14(2):323-8.