Clipless Technique of Laparoscopic Cholecystectomy Using the Harmonic Scalpel

Vu, Thai; Aguilo, Rachel; Marshall, NC

doi:10.1308/rcsann.2008.90.7.612a

Cited by 10 publications

(9 citation statements)

References 2 publications

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“…Bleeding during LC either from a slippage of clips from the cystic artery or bleeding from the GB fossa may make the operating field blurred, which may pose an advertent injury to the biliary system and prolongs the operating time. The safety of the harmonic scalpel for vessel ligation has been shown by Vu et al in laparoscopic surgery [ 14 ]. As the cystic artery system is not a high-pressure zone, ligation and division of the cystic artery with a harmonic scalpel may be advantageous, as ligation and division can be done using a single instrument.…”

Section: Discussionmentioning

confidence: 99%

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Kumar¹,

Sureshkumar²,

Ali³

et al. 2018

Cureus

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IntroductionLaparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Routinely used electrocautery produces more smoke, which masks the operating field, thereby prolongs the surgery and posing an increased risk of gallbladder (GB) perforation. The titanium clips used for clipping the cystic artery and cystic duct have a risk of slippage, which may lead to bleeding, and an increased risk for bile leakage. In addition, it may act as a nidus for stone formation. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. However, evidence to substantiate this advantage is limited.AimTo compare the operating time and perioperative complications between conventional laparoscopic cholecystectomy (CLC) and harmonic scalpel assisted laparoscopic cholecystectomy (HLC).MethodologyAll consecutive patients who underwent elective LC were included. Patients with acute infection, impaired liver function tests, concomitant common bile duct calculi, chronic liver disease/cirrhosis, suspected GB carcinoma, and pregnant women were excluded from the study. Patients were allocated into two groups. In the CLC group, both the cystic duct and the cystic artery were divided after conventional titanium clip application and electrocautery was used for thermal energy. In the HLC group, the cystic duct was clipped with a titanium clip and the rest of the procedure was carried out using Harmonic Ace (Ethicon, New Jersey, United States) and Harmonic Hook (Ethicon, New Jersey, United States). Outcome parameters analyzed were operating time in minutes, post-operative pain using visual analogue scale (VAS) scoring, frequency and route of analgesic requirement after 24 hours, and intraoperative complications, including bleeding, bile duct injury, GB perforation, and surgical site infection (SSI) in the postoperative period, per the Centers for Disease Control (CDC) criteria.ResultsBoth the groups were comparable with respect to age, gender, body mass index (BMI), and the presence of comorbidity and an indication of cholecystectomy. The duration of surgery did not significantly differ between the groups (67.3 vs. 64.3 mins; p = 0.30). Other parameters, such as analgesic required on postoperative Day 1 (3.2 vs. 3; p = 0.67), VAS scores on Day 0 (4.55 vs. 4.65; p = 0.59), VAS scores on Day 1 (2.3 vs. 2.2; p = 0.84), superficial SSI (15% vs. 10%; p = 0.63), intraoperative GB perforation (30% vs. 20%; p = 0.71), and intraperitoneal drain (30% vs. 20%; p = 0.71) did not significantly differ between the groups.ConclusionHLC has no significant advantage over CLC with respect to operating time, postoperative pain, and perioperative complications.

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Section: Discussionmentioning

confidence: 99%

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Kumar¹,

Sureshkumar²,

Ali³

et al. 2018

Cureus

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“…It has been shown to be effective, efficient, and a safe alternative for dissection and hemostasis. [90][91][92] In addition, harmonic scalpel has also been shown to be associated with fewer complications (mild or major bile leaks and gallbladder perforation) and shorter operation time. Use in acute cholecystitis has also shown to be safe.…”

Section: Discussionmentioning

confidence: 99%

Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases

Chong

2010

Journal of Gastrointestinal Surgery

102

139

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“…It involves less pain and almost minimal chances of port site infections and necrosis. [19][20][21][22]…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clipped Laparoscopic Cholecystectomy and Clipless Laparoscopic Cholecystectomy in Context of Biliary Leakage

Khan¹,

Shar²,

Memon³

et al. 2023

PJMHS

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Objective: To compare the outcome of clipped laparoscopic cholecystectomy and clipless laparoscopic cholecystectomy in context of biliary leakage. Study Design: Cross-sectional analytical study Place and Duration of Study: Department of Surgery Unit-II, Benazir Bhutto Hospital Rawalpindi from 1st September 2021 to 31st August 2022. Methodology: One hundred and twenty patients were included in the study and divided into two major groups. The biochemical analysis and ultrasonography was performed post 8 hours fasting. Group one had those cases which underwent clipped laparoscopic cholecystectomy while group 2 had those cases which underwent clipless laparoscopic cholecystectomy. The age of the patients was selected between 40 to 60 years and the prevalence for this sampling was considered as 20% in Pakistan. The demographic details, clinical history, signs and symptoms, clinical diagnosis based on USG, lipid profiling, and variables as post-operative time, hospital stay and ease in procedure were documented. Results: The mean age of the cases underwent clipped laparoscopic cholecystectomy was 42.3±12.11year with 40 females and 20 males who underwent those procedures. The mean age of the cases underwent clipless laparoscopic cholecystectomy was 40±11.05 years with 45 females and 15 males. The present study results evidently highlighted the fact that there were high percentage cases of biliary leakage seen in clipped cases than in the clipless cases. There were22 cases with 36.6% in clipped groups while 9 cases with biliary leakage such as 15% in clipless group. Conclusion: Clipless laparoscopic cholecystectomy is a better optional procedure with efficient usefulness in context to biliary leakage, operation time and hospital stays. Keywords: Outcome, Clipped laparoscopy cholecystectomy, Clipless laparoscopic cholecystectomy, Biliary leakage

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Clipless Technique of Laparoscopic Cholecystectomy Using the Harmonic Scalpel

Cited by 10 publications

References 2 publications

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial

Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases

Comparison of Clipped Laparoscopic Cholecystectomy and Clipless Laparoscopic Cholecystectomy in Context of Biliary Leakage

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