Objective: To demonstrate the efficiency and safety of Harmonic scalpel in comparison with electrocautery for gallbladder dissection and hemostasis in laparoscopic cholecystectomy. Patients and methods: A prospective comparative, study was done at Al-Jamhori Teaching Hospital in Mosul, during the period from 1 st of January 2010 to 1 st of January 2012. Three hundred and twenty patients underwent laparoscopic cholecystectomy, the following criteria were applied for selection: they had chronic cholecystitis, no complaint at time of operation, age between 25 to 50 years, normal body weight, with American Score of Anesthesia (ASA) of 1 or 2, no previous upper abdominal operation, no, or well controlled hypertension or diabetes, gall bladder wall thickness with less than 6 mm by preoperative ultrasonography and all the patients were operated by the authors. The patients were divided into two groups according to the instrument used for dissection of gall bladder from its bed, the first group with electrocautery and second group with harmonic scalpel. The time needed for complete dissection and hemostasis started from spreading of Calot's triangle till removal of gall bladder totally from its bed, was recorded. Any intra operative complications: bleeding, gallbladder perforation, slipped stones, or conversion were recorded. Results: The study included 320 patients, 172 patients belonged to the first group (electrocautery) and 148 patients belonged to second group (harmonic). For the first group, the median time was 17 minutes, the mean time was 17.7 minutes and the mode was 13 minutes, while that for second group, the median time was 14 minutes, with a mean time of 16 minutes and a mode of 14 minutes. Intra-operative bleeding was recorded in 34 (20%) for the first group and 17 (11%) for the second one. Gallbladder perforation was recorded in 26 (15%) patients and slipped stone in 12 (7%) patients in the electrocautery group and 13(9%) and 5 (3%) respectively in the harmonic group. No common bile duct injury was recorded in either group. Conversion was needed in 4 patients (1.3%), 3 (2%) patients belonged to the first group and one (06%) to the second group. Conclusion: Harmonic scalpel is very safe and effective instrument for dissection of gall bladder and hemostasis in laparoscopic cholecystectomy and can replace electrocautery for this purpose if available at operative theater.

The study is designed to evaluate the confidence, reliance and the degree of acceptance of laparoscopic surgical procedures among Mosul city population after 15 years of work in this field of surgery. This is a prospective data collection study. Participants were eight hundred persons, all of them from Mosul city with complete normal health at time of evaluation; all of them were above 18 years of age. The main outcome measures: The persons involved were divided into 4 groups according to their literate and educational level, each group composed of 200 persons, the first group (literate medical personnel) composed of medical doctors of various specialties, the second group (literate non medical personnel) composed of persons who were graduated from various colleges, apart from medical one. The third group (partially literate personnel) included those who did not complete the secondary school. the fourth group (low literate personnel) included those who did not completed the primary school. The questioners asked the following questions: 1-Did you know what laparoscopic surgery means? A special information score was used to evaluate the questioner knowledge. To those who answer yes for the first question and the information score was acceptable, the second question was: 2-Do you prefer this type of surgery to be used on you or on one of your first relative if feasible and needed? 3-If the answer for question 2 is yes, please tell us why. 4-If the answer for question 2 is no, please tell us why. The data were collected and comparison was done among the groups. All the medical persons were aware about laparoscopic surgery, 183 agreed to underwent such procedure if needed during the coming time, 160 of the second group knew what is laparoscopic surgery and 123 accepted to be used on them if needed, 118 of the third group knew what is laparoscopic surgery and 80 agreed to be used on them, while 85 of the fourth group had information about laparoscopic surgery but only 42 of them accepted it to be used on them if needed. Those who accepted laparoscopic surgery did so because they think that, it is more cosmetic, less painful and needs less hospitalization time, while those who refused it, did so because they afraid from dangerous instrument, the risk of complication and conversion. In conclusion, laparoscopic surgery is a well known surgical procedure among population in Mosul city, it gained acceptance and confidence especially in literate persons, but it needs more verification for low literate population. Cosmetic, less hospitalization and less post operative pain are the stocks for acceptance while complications, conversion and untrusting instrument and surgeon are the reasons for refusal of laparoscopic surgery.