The Use of Harmonic Scalpel for Laparoscopic Clip less Cholecystectomy
Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is accepted as the ‘‘gold standard’’ surgical treatment of gallstones. Although surgical clip (SC) is known to be a safe closure method for cystic duct and artery, bile leakage due to clip displacement from the cystic duct stump is a potential complication. In recent years, some energy sources have been tried for the closure of the cystic duct. After the beginning of the use of a harmonic scalpel (HS) for sealing of the cystic artery, surgeons started to investigate the role of HS for sealing the cystic duct. The aim of this study was to assess the efficacy and safety of the use of HS in performing LC.
OBJECTIVE: To assess the safety and efficacy of HS, as an effective alternative to clipping, for achieving perfect haemobilliary stasis in LC.
MATERIAL AND METHODS: This study was carried out on 70 patients over a period of 2 years. It included 29 males and 41 females with a mean age of 40.6±12.3 years. Most of the cases (42.9%) were operated within 35-44 minutes with a range of 25-64 minutes.
RESULTS: LC was successful in all patients, with no need to convert into open technique. Gall bladder (GB) perforation occurred in 8.6% of cases. None of the patients had intraoperative cystic duct leaks. Postoperative drainage was haemoserous in all patients with no bile or frank blood. The mean hospital stay was 1.3±0.72 days.
CONCLUSION: Harmonic scalpel is a safe and effective alternative to clipping for LC, ensuring perfect haemobilliary stasis. It has the advantages of a lower incidence of GB perforation and shorter operative time. The major limitation is its cost and apprehension of insecurity in using it in mega cystic duct >6 mm.
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